Privacy Complaint Form
Parents/guardians of a student (a student who is at least 18 years of age or attending a post secondary institution at any age), teachers, principals, and employees of an educational agency are eligible to submit a privacy complaint.

A privacy complaint may also be submitted in writing to:
Privacy Complaint
Chief Privacy Officer
NYS Education Department
89 Washington Avenue
Albany, NY 12234

Please do not include any information that would constitute student personally identifiable information (PII). If we need any further information, Wyoming Central School will contact you.
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First Name *
Last Name *
Phone Number *
Email Address *
Role: *
Date Violation Occurred *
MM
/
DD
/
YYYY
Name(s) of persons involved? *
Name of school(s) involved? *
Description of data compromised? *
Description of improper disclosure? *
Contacts for additional information
Enter names and contact information for individuals that may provide additional information.
Certification *
I certify that the information I provided is true to the best of my knowledge.
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