Russell Byers Charter School
General Complaint Form
Date:
Complainant Information
Name:
Student Name:
Best Phone Number: Best Email:
Stake Holder Group: If other, please describe:
Complaint Details:
Date of Incident:
Please complete the following to the best of your ability
Time of Incident:
Location of Incident(if known):
Person(s) Involved(if known):
Please provide a brief description of the issue:
Desired Resolution - What outcome are you seeking?
If you have any supporting evidence (pictures, statements, police reports, videos, etc.
please attach/share with the front desk staff.
Signature: