Data Breach / Unauthorized Release 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/or protected teacher or principal data using this form.
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Email *
Last Name, First Name *
Role / Relationship to Student: *
Mailing Address *
Telephone Number *
Students Name *
School Building(s) *
Required
POSSIBLE IMPROPER DISCLOSURE OR BREACH INFORMATION
Description of Event(s): *
Description of Possible Disclosed Data: *
Description of How Reporter Learned of Possible Disclosure: *
A copy of your responses will be emailed to the address you provided.
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