Data Privacy Violation Complaint Form
Parents, eligible students (students who are at least 18 years), principals, teachers, and other employees of the Valley Central School District may file a complaint about a possible breach or improper disclosure of student data and/or protected teacher, principal data using this form.  A data privacy complaint should be sent to the District’s Data Protection Officer at:
Valley Central School District
Tammy Coleman, DPO
944 State Route 17K
Montgomery, NY  12549

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Contact Information
First Name: *
Last Name: *
Phone Number: *
Email: *
Role/Relationship to Student (if applicable):
Building Affiliation: *
Required
Possible Improper Disclosure or Breach Information
Description of Event: *
Description of Possible Disclosed Data: *
Description of How Complainant Learned of Possible Disclosure: *
Any Further information:
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