La Joya Independent School District Office of Student Services Student, Parent or Guardian Complaint Form

Level One

District’s policy FNG

Name of Parent:/ Nombre del Padre:

Date:/ Fecha:

Student Name:/ Nombre de Estudiante: School:/ Escuela:

Grade Level:/ Grado:

Nature of Complaint:/ Queja: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Remedy:/ Remedio:

____________________________________________________________________________________ ____________________________________________________________________________________ Parent Signature:/Firma de Padre: ****************************FOR OFFICE USE ONLY********************************* Action Taken:/ Solucion:

Marina Abdullah Executive Director for Student Services

Date