Peralta District Elections Protest Form
All information must be completed and submitted by the deadline for consideration. Anonymous forms will not be accepted. Please be advised that knowingly filing a frivolous or bad faith complaint may subject the individual filing the complaint to disciplinary action. All Election Protest forms must be received by May 20, 2022 by 5:00 p.m.

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Full Name *
Email address *
Phone *
Campus where the violation occured *
Date of the Violation *
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Name(s) of the person(s) the complaint is being filed against: *
List the specific election code and/or district policy that were allegedly violated: *
Provide a brief description of the alleged violation: *
Provide the names and contact information for person(s) that witnessed the incident: *
By checking the box below I understand that this information is not confidential and will be discussed by the appropriate campus election committee in a public meeting. In addition, you acknowledge that the signature(s) of the griever(s) on this form constitute(s) an acceptance of any decision made by the Election Committee regarding the specified grievance. *
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