PUBLIC CONCERNS AND COMPLAINTS
(This Form to be Submitted to the Superintendent)
Person(s) or group filing complaint ____________________________________
Complainant's address _________________________ Phone ________________
Complainant's E-mail address ____________________________________________
Date complaint is filed ________________________________________________
Has problem been discussed with the administration?
¨ Yes ¨ No Date __________________________________________
Summary of the charges (description of incident or event, including date, place, time, additional persons, alleged problem, and suggested solution):
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Identification of other witnesses or persons with information about concern:
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The projected solution
Indicate what you think can and should be done to solve the problem. Be as specific as possible.
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Signature of complainant Date
The administration shall give one (1) copy to the complainant and shall retain one (1) copy for the file.