Online Complaint Form

Reporting Status*

Complainant Information

First Name

Last Name

Email Address

Contact Number

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Association with the School

Complaint Details

School Type*

LEA*

Private School*

School

Site

The school did not adhere to the following School Immunization Policy requirements:


	The school did not provide proper notification prior to excluding students.

	The school did not exclude students who were out of compliance with the School Immunization Policy.

	The school excluded students who were in compliance with the School Immunization Policy.

	The school inequitably excluded some, but not all, students who were out of compliance with the School Immunization Policy.

Please describe the nature of the compliant