COMPLAINT FORM: WILLIAMS UNIFORM COMPLAINT PROCEDURES
Complaints may be filed anonymously. However, if you wish to receive a response to your complaint, you must provide the contact information below. Response requested? ___ Yes ___ No
Phone Number: Day:___________________________Evening:___________________________
E-mail address, if any:____________________________
Location of the problem that is the subject of this complaint:
Course title/grade level and teacher name:____________________________
Room number/name of room/location of facility:____________________________
Date problem was observed:____________________________
Only the following issues may be the subject of this complaint process. If you wish to complain about an issue not specified below, please use the appropriate district complaint procedure.
Specific issue(s) of the complaint: (Please check all that apply: A complaint may contain more than one allegation.)
1. Textbooks and instructional materials: (Education Code 35186; 5 CCR 4681)
____A student, including an English learner, does not have standards-aligned textbooks or instructional materials or state- or district-adopted textbooks or other required instructional materials to use in class.
____A student does not have access to instructional materials to use at home or after school. This does not require two sets of textbooks or instructional materials for each student.
____Textbooks or instructional materials are in poor or unusable condition, have missing pages, or are unreadable due to damage.
____A student was provided photocopied sheets from only a portion of a textbook or instructional materials to address a shortage of textbooks or instructional materials.
2. Teacher vacancy or misassignment: (Education Code 35186; 5 CCR 4681)
____A semester begins and a teacher vacancy exists. A teacher vacancy is a position to which a single designated certificated employee has not been assigned at the beginning of the school year for an entire year or, if the position is for a one-semester course, a position of which a single designated certificated employee has not been assigned at the beginning of a semester for an entire semester.
____A teacher lacking credentials or training to teach English learners is assigned to teach a class with more than 20% English learners in the class.
____A teacher is assigned to teach a class for which the teacher lacks subject matter competency.
3. Facility conditions:
____A condition exists that poses an emergency or urgent threat to the health or safety of students or staff as defined in AR 1312.4.
Please describe the issue of your complaint in detail. You may attach additional pages and include as much text as necessary to fully describe the situation. For complaints regarding facilities conditions, please describe the emergency or urgent facilities condition and how that condition poses a threat to the health or safety of students or staff. ___________________________________________________________________________
Please file this complaint with the person specified below at the following location:
Emma Pereida-Martinez, Superintendent/Principal
14713 Weedpatch Hwy
Please provide a signature below. If you wish to remain anonymous, a signature is not required. However, all complaints, even anonymous ones, should be dated.
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