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Sample Williams Complaints Form

The Sample Williams Complaints Form is for LEAs to have available for reporting Williams-related UCP (Uniform Complaint Procedures) complaints according to California Code of Regulations, Title 5.

Sample Williams Complaints Form

This Sample Williams Complaints Form below is for local educational agencies (LEAs) to make available to anyone who wants to file a complaint regarding a Williams-type issue. A Williams issue concerns deficiencies related to instructional materials, conditions of facilities that are not maintained in a clean or safe manner or in good repair, teacher vacancy or misassignment, and/or intensive instructional services not being provided to pupils who have not passed one or both parts of the high school exit examination at the end of grade 12. This form contains elements required by California Education Code Section 35186 and 5 CCR Sections 4600-4687.

Education Code (EC) Section 35186 created a procedure for the filing of complaints concerning deficiencies related to instructional materials, conditions of facilities that are not maintained in a clean or safe manner or in good repair, and teacher vacancy or misassignment. The complaint and response are public documents as provided by statute. Complaints may be filed anonymously. However, if you wish to receive a response to your complaint, you must provide the following contact information.
Response requested:  Yes  No

Name (Optional):

Mailing Address (Optional):

Phone Number Day (Optional):

Evening (Optional):

Issue of complaint (please check all that apply):

1. Textbooks and Instructional Materials

2. Facility Conditions

3. Teacher Vacancy or Misassignment

4. High School Exit Examination (For school districts with grades 10 through 12 who receive intensive instruction funds)

Date of Problem:

Location of Problem (School Name, Address, and Room Number or Location):

Course or Grade Level and Teacher Name:

Please describe the issue of your complaint in detail. You may attach additional pages if necessary to fully describe the situation.

Please file this complaint at the following location:
(Principal or the designee of the district superintendent and address)

Questions:   Categorical Programs Complaints Managment Office| 916-319-0929
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