Citizen Complaint Against An Employee Of The San Diego Unified School District

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CITIZEN COMPLAINT AGAINST AN EMPLOYEE
OF THE SAN DIEGO UNIFIED SCHOOL DISTRICT
(Administrative Procedure 9430)
TO:
San Diego Unified School District
Attn: Superintendent
4100 Normal Street, Room 2219
San Diego, CA 92103
FROM:
Name(s) ______________________________________________________________________
Address _________________________________________ Zip Code_____________________
Telephone (H) (___)_____________(W) (___)_______________(Cell) (___)_______________
Student Name(s) _______________________________________________Grade___________
School _______________________________________________________________________
I understand that a copy of this complaint will be provided to the
employee(s) immediately upon receipt of this complaint.
Name and title of person(s) against
whom complaint is made:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Employee’s work location:
____________________________________________________________
Nature of complaint. (This should be a description, in your own words, of the grounds for your complaint,
including all names, dates, and places necessary for a complete understanding of your complaint. Attach
additional pages if needed.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Date(s) on which you discussed the complaint with the employee(s):
_____________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________________________________________________
__________________________________________________________________________________________
Date(s) you discussed the complaint with the principal or employee’s supervisor (include names):
Date(s) you discussed the complaint with the principal or employee’s supervisor (include name[s]):
__________________________________________________________________________________________
_________________________________________________________________________________________

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