J-1032          JFABD-EB  

EXHIBIT          EXHIBIT

ADMISSION  OF  HOMELESS  STUDENTS
(Complaint Form)

Person(s)  filing complaint _____________________________________________

Complainant can be contacted as follows      ________________________________

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Date complaint is filed ________________________________________________

Student name and grade ______________________________________________

Has problem been discussed with the administration?

Yes  No                           Date _________________________________________

Information the complainant wishes to have considered:

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Other persons with information about concern:

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The projected solution

Indicate what you think can and should be done to solve the problem.  Be as specific as possible.

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Signature of complainant     Date

 

The administration shall give one (1) copy to the complainant and shall retain one (1) copy for the file.