Unauthorized Disclosure Complaint Form
Parents, eligible students (students who are at least 18 years of age or attending a postsecondary institution at any age), principals, teachers, and employees of an educational agency may file a complaint about a possible breach or improper disclosure of student data and protected teacher or principal data. The below information collected will be sent directly to:

John Novak, Data Protection Officer
jnovak@letchworth.k12.ny.us
Letchworth Central School
5550 School Road
Gainesville, NY 14066
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Full Name: *
Phone Number: *
Email Address: *
Role/Relationship to Student: *
District/Building Affiliation: *
Name of Student: *
Brief Non-detailed Exposure of Data *
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