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Standard School District

1200 N. Chester Avenue

Bakersfield, CA 93308-3521

COMPLAINT FORM

Instructions: Describe your complaint or concern below. Be certain to include a description of any incident(s), date(s) of occurrence(s), and name(s) of person(s) involved. Please sign and date your statement and return to the Education Service Center. Any further processing of the complaint shall be in accordance with School Board Policies 1312.1, 1312.2, and 1312.3. Efforts should be made to resolve the matter at the earliest possible stage.

PERSON FILING COMPLAINT: DATE:

ADDRESS:

TELEPHONE NUMBER:

STATEMENT OF COMPLAINT

____________________________________

Signature of Person Filing Complaint

Exhibit STANDARD SCHOOL DISTRICT

version: September 11, 2012 Bakersfield, California