Complaint Form

Complaint Form

Name  Telephone Number 



          (Street, City, Zip Code)

 of , at 

(Parent/Guardian/Student)        (Name of Student/Grade)                (School)

and I allege that  a, , at 

              (Name of Accused Party)  (Parent, Guardian, Teacher, Student, Other)  (Name of School)

Engaged in the following act or conduct prompting this complaint:


(Signature of Parent/Guardian)             (Date)

This is my desired outcome:

I request this complaint be investigated. (Form must be signed)


         (Date)             (Signature of Person Filing Complaint)




Security Measure