Parent 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.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Student Name *
Phone Number *
Email *
Role/Relationship to Student *
District/Building Affiliation *
Description of Incident *
Date of Incident *
Description of How Reporter Learned of the Possible Disclosure *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Genesee Valley BOCES. Report Abuse
Google Forms