Public Concerns and Complaints Form
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Public Concerns and Complaints Form
(This form to be submitted to Administration)
1.
Person(s) or group filing complaint:
*
2.
Complainant's address:
3.
Phone:
*
xxx.xxx.xxxx
4.
Date complaint is filed:
*
mm/dd/yy
5.
Has problem been discussed with the administration?
*
Has problem been discussed with the administration?
*
Yes
No
6.
If yes, please provide the date:
7.
Summary of the charges ( description of incident or event, including date, place, time, additional persons, alleged problem, and suggested solution):
8.
Identification of other witnesses or persons with information about concern:
Just an example.
OK