Exhibit C — Student / Parent Complaint — Level Two Appeal Notice
To appeal a Level One decision, or the lack of a timely response after a Level One conference, please fill out this form completely and submit it within the time established in FNG(LOCAL). Appeals will be heard in accordance with FNG(LEGAL) and (LOCAL) or any exceptions outlined therein. A person filing a complaint regarding refusal of entry to or ejection from property under the District’s control based on Education Code 37.105 will be permitted to address the Board in person within 90 calendar days of filing the initial complaint unless the complaint is resolved before reaching the Board. [See GKA]
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Campus
*
Please Select
Fairfield High School
Fairfield Junior High
Fairfield Intermediate School
Fairfield Elementary School
If you will be represented in presenting your complaint, please identify the person representing you.
Represented by- Name
First Name
Last Name
Represented by- Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Represented by- Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Represented by- Email
example@example.com
Who held the Level One conference?
*
Date of conference:
*
-
Month
-
Day
Year
Date
Date you received a response to the Level One conference:
*
-
Month
-
Day
Year
Date
Please explain specifically how you disagree with the outcome at Level One.
*
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Student’s or parent’s signature:
*
Signature of student’s or parent’s representative:
Date of filing:
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Complainant, please note:
If you are initiating a formal complaint with the District, please use the Exhibit A — Level One form. The appropriate level administrator or level hearing will be designated to respond to the complaint in accordance with this policy. A complaint or appeal form that is incomplete in any material way may be dismissed but may be refiled with all the required information if the refiling is within the designated time for filing a complaint or appeal.
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