Name of Complainant
Title
Organization
Street address
Address (cont.)
City	Choose one of the following cities: El Cerrito El Sobrante Hercules Kensington Pinole Richmond San Pablo
State
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail

Name of School: Choose one of the following schools:

Administration Building Adams Bayview Castro Chavez Collins Crespi De Anza Delta Dover Downer El Sobrante Ellerhorst Farimont Ford El Cerrito Gompers Grant Hanna Ranch Harding Helms Hercules Highland Kappa Kensington Kennedy King Lake Lincoln Madera Middle College Mira Vista Montalvin Murphy North Campus Nystrom Ohlone Olinda Omega Peres Pinole Middle Pinole Valley High Portola Richmond Riverside Seaview Shannon Sheldon Sigma Stege Stewart Tara Hills Valley View Verde Vista Washington Wilson

 

If the complaint is against a program or policy, please follow the instructions in the Uniform Complaint Procedure and complete either Section A or Section B below.

Section A: I am filing a complaint alleging a violation of federal or state statutes related to this program:

I have I have not discussed this with the principal/program manager.

Section B: I am filing a complaint allleging a violation of a board policy related to:

I have I have not discussed this with the Special Assisatnat to the Superintendent.

 

If the complaint is against a district employee, plesase follow the instructions of the Parent Complaint Procedure.

I am filing a complaint against

Please write comments in the white field below:

Please print this form and mail to :

West Contra Costa Unified School District

Area Director

1108 Bissell Avenue

Richmond, CA 94801