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Uniform Complaint Procedure Form/Formulario de Procedimiento Uniforme de Quejas
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Your Last Name
Your answer
Your First Name
Your answer
Student Name (if applicable)
Your answer
Date of Birth
MM
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DD
/
YYYY
Street Address/Apt. #
Your answer
City
Your answer
State
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Option 1
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Zip Code
Your answer
Home Phone
Your answer
Message/Work Phone
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Description of Complaint
Your answer
Unlawful Discrimination/Harassment-Please check one or more of the following
Race
Color
Age
Actual or Perceived Sex
Gender
Ethnic group Identification
Ancestry
Religion
National Origin
Mental or Physical Disability
Other:
Please give facts about the complaint. Provide details such as names of those involved, dates, whether witnesses were present, etc., that might be helpful to the complaint investigator.
Your answer
Have you discussed your complaint or brought your complaint to any Academia Avance Charter School personnel? If you have, those whom did you take the complaint, and what was the result?
Your answer
Please supply copies of any written documents that may be relevant or supportive of your complaint
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I have sent supporting documents
Yes
No
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