Jefferson Central School Unauthorized Disclosure Complaint Form
Student(s), Eligible Student(s), Parent(s), Teacher(s) or Principals and other Jefferson Central School staff who have information indicating there has been a Breach or Unauthorized Disclosure of Protected Data may report that information to the Data Protection Officer, or DPO, by completing the form below.

Additional Information:

After submitting the form, the DPO will promptly acknowledge receipt of the report within 24 hours.

When the factfinding process is complete, the DPO will provide the reporting party with the findings made at the conclusion of the factfinding process; this should occur no later than 60 days after the receipt of the initial report, and, if additional time is needed, the reporting party shall be given a written explanation within the 60 days that includes the approximate date when the findings will be available.

Please note that the Jefferson Central School DPO shall maintain a record of each report received of a possible Breach or Unauthorized Disclosure, the steps taken to investigate the report, and the findings resulting from the investigation in accordance with applicable record retention policies.
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Email *
First Name *
Last Name *
Phone Number
Email
Role
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Description of Event(s):
Description of How Reporter Learned of Possible Disclosure:
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