ROCHESTER CITY SCHOOL DISTRICT           Critical Feedback Line
This form is intended to receive critical feedback for District Leadership. You are not required to leave your name.  Your anonymity regarding this feedback will be respected. We do require detailed information to consider your feedback.  Please try to relay factual information as opposed to opinions.
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Are you a Student, Employee, Parent/Guardian, or Other?  Select One of the above. *
What department is this feedback for?  Select one or more departments. *
Required
If this relates to a specific school, please provide the name.
Is there a specific individual this feedback is for?    Provide name and/or title, otherwise enter Unknown. *
Please document your concern with as much detail as possible.  Include dates, locations and any relevant supporting information to evaluate your concern. *
Were there any other witnesses for the concern that you documented above? Please include names and known contact information, otherwise state None. *
Did you hear or observe this first hand or through someone else? *
Who else was your concern communicated to? Please include names and known contact information, otherwise state None. *
If you did communicate to someone, when did that occur? (Include dates and times)
What made you decide to communicate this concern at this time? *
How has the situation that you are communicating affected you? *
Do you have any suggestions on how to make this situation better? *
You can choose to remain anonymous or you can leave a name and number for someone to call you back to obtain additional information.
Please print prior to submission for your own record.
THANK YOU for providing feedback.  
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