Section 504 Grievance Form
Date
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Month
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Day
Year
Student Information
Please provide information for the student.
Child's Name
*
First Name
Last Name
Child's Date of Birth (DOB)
*
-
Month
-
Day
Year
Date
Child's School
*
Please Select
The Bayard School
Brader Elementary School
Brennen School
Brookside Elementary School
Christiana High School
Christina Early Education Center
CSD Virtual Academy - Gallaher
CSD Virtual Academy - Kirk
CSD Virtual Academy - Sarah Pyle Academy
Delaware School for the Deaf
Douglass School
Downes Elementary School
Gallaher Elementary School
Gauger-Cobbs Middle School
Glasgow High School
Jones Elementary School
Keene Elementary School
Kirk Middle School
Leasure Elementary School
Maclary Elementary School
Marshall Elementary School
McVey Elementary School
Middle School Honors Academy at CHS
Networks School for Employability Skills
Newark High School
Oberle Elementary School
Pritchett Academy
Pulaski Early Education Center
REACH Program
Sarah Pyle Academy
Shue-Medill Middle School
Smith Elementary School
Stubbs Early Education Center
West Park Place Elementary School
Wilson Elementary School
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Complainant Information
Please provide information for the person filing the complaint.
Complainant’s Name
*
First Name
Last Name
Complainant’s Phone Number
*
Please enter a valid phone number.
Complainant’s Email
*
example@example.com
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Details of Concerns
Please describe your concerns and why you believe they raise an issue under Section 504. Include a description of what happened, when and where it happened, and who was involved.
*
Explain the steps you have already taken to resolve the issue, if any.
*
Describe what resolution to your concerns you would like to see.
*
Please attach any documents or other information you think will help with the investigation of your complaint.
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