Unauthorized Disclosure Complaint Form
Please use this form if you feel that there has been a breach of a student's PERSONAL IDENTIFIABLE INFORMATION through The Coxsackie-Athens School District. Please provide as much information as possible when completing the form.   The district will immediately review all reports submitted using this form.

After the investigation has concluded the findings will be provided to the complainant within the required timeline (60 days). All records will be retained for the required length of time required by New York State.
Email *
What is your first and last name?  *
What is your phone number? *
What is your email address so we can contact you in the future?  *
What is your position as you complete the complaint form? *
Which school do you engage with? *
Please provide the First and Last name of  the employee or student for whom breach may have occurred.
 *
Describe the events you are reporting. *
Please describe the data that you feel was disclosed inappropriately.
 *
Describe how you learned of this possible disclosure. *
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