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215.1E1 Public Complaint Form

Code No 215.E

Riverside Community School District

Public Complaint Form

Complainant Name:__________________       Signature: ________________________

Complainant Address:_________________________________________________________

Home Telephone:____________________       Work Telephone:____________________

Today's Date:______________________       Date Situation Occurred:___________

In the space provided describe the situation in question:____________________

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What solution do you seek?___________________________________________________

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Response by 1st district employee to handle situation:_______________________

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Employee Signature:____________________________

Date: _________________________________________

If not resolved earlier, Supervisor/Principal Comments:______________________

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Supervisor/Principal Signature:______________________________________________

Date:__________________________________________

If not resolved earlier, Superintendent's Comments:__________________________

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Superintendent’s Signature:________________________________

Date:__________________________________________ 

Reviewed: 4-18-2022