Please complete the following form if there is a complaint against any school site, program, BSD USE ONLY office or School District employee. Submit the completed complaint form to your school Date Received: administrator. The District will provide the person filing the complaint a confirmation that the complaint Received by: has been received, the name of the person responsible for investigating the complaint, and the process to follow. Please refer to for specific process and timelines for your complaint. Name of person completing the form Date I don’t want to share my name Phone Number Email Name of school, program or office or name of employee and job location against whom complaint is directed Name of student(s) (if applicable) Place a check next to the kind of complaint you are making: And/or Discrimination on basis of: If your complaint involves a specific program: Transfers Age Program for English Learners Transportation Ancestry and/or National Origin Career Technical Education Student Grades Color Child Nutrition Instruction Ethnic Group Identification Gifted and Talented Education Student Safety Gender Special Education Restraint & Seclusion Marital Status Title I No Child Left Behind – (please list) Physical / Mental Disability Division 22 Standards Race (please list) Religion Sexual Harassment Sexual Orientation Other Harassment Other did the incident happen? What happened during the incident? Was anybody physically hurt?
Please complete the following form if there is a complaint against any school site, program, office or School District employee. Submit the completed complaint form to your school administrator. The District will provide the person filing the complaint a confirmation that the complaint has been received, the name of the person responsible for investigating the complaint, and the process to follow. Please refer to for specific process and timelines for your complaint. BSD USE ONLY Date Received: Received by: Name of person completing the form I don’t want to share my name Date Phone Number Email Name of school, program or office or name of employee and job location against whom complaint is directed Name of student(s) (if applicable) Place a check next to the kind of complaint you are making: And/or Discrimination on basis of: If your complaint involves a specific program: Transfers Transportation Student Grades Instruction Student Safety Restraint & Seclusion (please list) Age Ancestry and/or National Origin Color Ethnic Group Identification Gender Marital Status Physical / Mental Disability Race Religion Sexual Harassment Sexual Orientation Other Harassment Other Program for English Learners Career Technical Education Child Nutrition Gifted and Talented Education Special Education Title I – No Child Left Behind Division 22 Standards (please list) did the incident happen? What happened during the incident? Was anybody physically hurt?
Unified%20Complaint%20Form.docx