Family Policy Compliance Office
U.S. Department of Education
600 Independence Avenue, SW
Washington, D.C. 20202-4605

I hearby lodge an official complaint against the School District of on behalf of who attends for what I believe to be the maintenance of inappropriate records/content or a violation of the Family Educational Rights and Privacy Act of 1974.

The nature of the complaint is as checked:

Challenge to Record or Content
inaccurate
misleading
incomplete
inappropriate

Record challenged may be identified as:
Title:
Date:
Person responsible for Entry or person currently maintaining record:
Date challenged content discovered:

Alleged Violations of Act or Regulations:

failure to provide notification of all rights (totally or in needed language)
failure to publish local access and hearing procedures
inappropriate person(s) grant denied access
failure to provide interpretation assistance as requested
failure to provide requested hearing
failure to provide uninvolved hearing officer
failure of hearing officer to provide written opinion within reasonable time
inappropriate sharing of confidential information
other

Date of Violation:
Date Violation Discovered if different from above:

Sincerely,
 

Home Phone: (not required)
Work Phone: (not required)