COMPLAINT FORM
Name:
Date:
Address:
Phone:
Email:
Position (student, teacher, parent, other):
Where you can be reached during daytime hours:
For allegation(s) of noncompliance, please list the categorically funded program or activity (please specify if possible):
For allegations(s) of unlawful discrimination/harassment, please list the basis of the unlawful discrimination/harassment:
Explain the nature of the complaint:
Signature:
All complaints should be submitted to the Petaluma City Schools Human Resources Department. If you are unable to put your complaint in writing, District staff is available to assist you in the filing of the complaint.
Exhibit PETALUMA CITY SCHOOLS
version: June 25, 2002 Petaluma, California
revised: April 28, 2009
revised: December 11, 2018