Equal Access to Public Schools in Oregon

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This form will help us collect data about the statewide loss of learning time and access to in person school for students with disabilities and other underserved populations in Oregon public schools. It will also help us write complaints to ODE, TSPC, local school districts and ESDs, BOLI and the federal government to get these kids back to full time learning.

Please fill out a separate form for EACH STUDENT whose experience you would like to have recorded in this project. YOU ARE NOT REQUIRED TO PROVIDE THE NAME OF THE STUDENT OR FAMILY.

Questions about this form can be sent to sen.saragelser@oregonlegislature.gov . We can also take your information over the phone if you prefer at 503-986-1708. We are working on translation services to be able to collect this data in additional languages.

Please send your email address so that we can follow up with you. If you do not wish to provide an email address, you can simply put sen.saragelser@oregonlegislature.gov in the email request section. However, we would really like to be able to follow up with you so that we can get help to each of these kids!

Email *

Name of Person Completing Form and Contact Information *

Name of Parent or Guardian of Impacted Student and Contact Information (Not required if you are uncomfortable)

Are you willing to be involved a formal complaint or complaints seeking restored access to school? (Please check all that apply) *

Yes

Maybe. I need more information.

I would want to be sure my student is not the only student named

I would only want to do it if my name was not on the complaint.

I would like to have the student's case included in the complaint but would like someone else to write it for me.

I would like to write the complaint myself, but I need help to do it

Required

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