SCSD Unauthorized Disclosure Complaint Form

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Please use this form if you feel that there has been a breach of a student's PII through SCSD, and provide as much information as possible. If you are a district teacher or principal, and feel that PII related to APPR information has been breached, please also fill out the form attached. Once we acknowledge receipt, an investigation will commence and SCSD will take the necessary precautions to protect PII.

Findings will be provided to the individual who filed the complaint no more than 60 calendar days from receipt. The district will keep the records of all complaints according to NYS requirements for records retention.

Complainant First Name *

Complainant Last Name *

Complainant Phone Number *

Please provide phone number in the following format xxx-xxx-xxxx

Complainant Email Address *

Complainant Role *

i.e. Eligible Student, Parent\Guardian, Teacher, Principal

Building Affiliation *

Cherry Lane Elementary School

Montebello Elementary School

Richard P Connor Elementary School

Sloatsburg Elementary School

Viola Elementary School

Suffern Middle School

Suffern High School

Central Office

Other:

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