Unauthorized Disclosure Complaint Form

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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 id student data and/or protected teacher or principal data.

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First Name: *

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Last Name: *

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Phone Number (Format ###-###-####) *

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Email address: *

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Role/Relationship Student(s): *

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District/Building Affiliation: *

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