Education Complaint Form The Santa Rosa – Sonoma County NAACP works to ensure that students who are most disproportionately impacted by school policies have access to great teaching, equitable resources, and a challenging curriculum. We are dedicated to eliminating the severe racial inequities that continue to plague our education system. Our ultimate goal is that every students receive a quality education that prepares them to be a contributing member of a democracy. The person who experienced the problem should normally fill in this form. If you are making a complaint on behalf of someone else please fill in Section B also. Your First Name(required) Your Last Name(required) Mailing Address(required) Mailing Address Line 2 City(required) State(required) Email Address(required) Contact Number(required) Which Best Describes You? Select one option Teacher School Employee Student Parent First Name of Complainant(required) Last Name of Complainant(required) Which is your relationship with the Complainant(required) Select one option Self Parent/Guardian Advocate Do we have permission to Advocate/Speak to District Representatives (including Superintendent, Principal, teachers Etc.) on your behalf? (required) Select one option Yes No Which is the Student's grade Level?(required) Select one option Pre-Kindergarten Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12 Does the Student have an IEP/504(required) Select one option Yes No What is the name of the school you are complaining about? (required) Type of complaint(required) Racial Harassments Bullying Discrimination IEP/504 Targeting behaviors involving teachers/administrator Suspension/Expulsion Other If other, please explain below. What date did this incident occur?(required) What time did this incident occur? (required) Describe what happened, and how this incident has affected you.(required) Did you fle a complaint with the school?(required) Select one option Yes No To whom did you report this incident, and what was their response? (required) What would you like the NAACP to do for you regarding the incident(s)? (required) Preferred method of contact Select one option Email Phone Mail Sumbit Δ
