NOTICE OF COMPLAINT AT LEVEL ONE
This form must be filled out completely by a student or parent filing a Level One complaint with the Principal, in accordance with FNG (LOCAL) or any exceptions outlined therein.
1. Student name _____________________________________________________________
2. Campus __________________________________________________________________
3. Address __________________________________________________________________
4. Home telephone ___________________________________________________________
5. To whom did you last present your complaint? ____________________________________
Date of conference ______________________
6. If you will be represented by a parent or other adult in pursuing your complaint, please identify the person representing you.
Name ________________________________________________________________
Address ________________________________________________________________
________________________________________________________________
Telephone number _________________________________________________________
7. Please state the date of the event or series of events causing your complaint. ___________
_________________________________________________________________________
8. Please state your complaint, including the individual harm alleged. ____________________
_________________________________________________________________________
_________________________________________________________________________
9. Please state specific facts that support your complaint (list in detail). __________________
_________________________________________________________________________
_________________________________________________________________________
10. Please state the remedy you seek for this complaint. _______________________________
_________________________________________________________________________
_________________________________________________________________________
__________________________________ ___________________________________
Student or Parent Signature Date Submitted