Skip to main content
California Department of Education Logo

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.

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.

NOTE: May use terms "pupil" and "student" interchangeably.


[Name of your Local Educational Agency (LEA)]

Williams Complaints Form

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

  • A pupil, including an English learner, does not have standards-aligned textbooks or instructional materials or state-adopted or district-adopted textbooks or other required instructional materials to use in class.
  • A pupil does not have access to textbooks or instructional materials to use at home or after school. This does not require two sets of textbooks or instructional materials for each pupil.
  • Textbooks or instructional materials are in poor or unusable condition, have missing pages, or are unreadable due to damage.
  • A pupil was provided photocopied sheets from only a portion of a textbook or instructional materials to address a shortage of textbooks or instructional materials.

2. Facility Conditions

  • A condition poses an urgent or emergency threat to the health or safety of students or staff, including: gas leaks, nonfunctioning heating, ventilation, fire sprinklers or air-conditioning systems, electrical power failure, major sewer line stoppage, major pest or vermin infestation, broken windows or exterior doors or gates that will not lock and that pose a security risk, abatement of hazardous materials previously undiscovered that pose an immediate threat to pupils or staff, structural damage creating a hazardous or uninhabitable condition, and any other emergency conditions the school district determines appropriate.
  • A school restroom has not been maintained or cleaned regularly, is not fully operational and has not been stocked at all times with toilet paper, soap, and paper towels or functional hand dryers.
  • The school has not kept all restrooms open during school hours when pupils are not in classes, and has not kept a sufficient number of restrooms open during school hours when pupils are in classes.

3. Teacher Vacancy or Misassignment

  • Teacher vacancy - 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 year for an entire year or, if the position is for a one-semester course, a position to which a single designated certificated employee has not been assigned at the beginning of a semester for an entire semester.)
  • Teacher misassignment - A teacher who lacks credentials or training to teach English learners is assigned to teach a class with more than 20 percent English learner pupils in the class.
  • Teacher misassignment - A teacher is assigned to teach a class for which the teacher lacks subject matter competency.

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 Management Office | 916-319-0929
Last Reviewed: Friday, June 5, 2015

Recently Posted in Complaint Procedures

  • Uniform Complaint Procedures Monitoring (updated 27-Jun-2016)
    Guidance for local educational agencies to meet compliance with Uniform Complaint Procedures (UCP) monitoring.
  • Sample UCP Pol and Pro (DOC) (added 20-Jun-2016)
    Sample Policies and Procedures assists LEAs in meeting the requirements in describing the UCP complaints process according to California Code of Regulations, Title 5.
  • Sample UCP Annual Notice (DOC) (added 20-Jun-2016)
    Sample UCP Annual Notice assists LEAs to annually notify their stakeholders of their UCP complaint procedures according to California Code of Regulations, Title 5.
  • Distribution of the UCP Annual Notice (DOC) (added 20-Jun-2016)
    This form is a questionnaire for agencies to complete before the FPM review to confirm the distribution of a valid UCP Annual Notice to their stakeholders by the end of the current school year.
  • Sample UCP Complaint Log for UCP 3 (PDF) (added 20-Jun-2016)
    Tool designed to assist LEAs in their preparation for the FPM online review of UCP 3.

  • Self-Cert for UCP 3 (DOC) (added 20-Jun-2016)
    Self-cert is for the LEA to complete before the FPM online review to report whether or not it filed UCP complaints within a 12-month period.
  • Self-Certification for UCP 5 (DOC) (added 20-Jun-2016)
    For the LEA to complete before its FPM online review declaring the proper implementation of the UCP process, consistent with the Williams Complaint requirements found in 5.0 of the UCP Instrument.
  • Williams Complaint Notice (DOC) (added 20-Jun-2016)
    Sample notice to explain complaints for Williams-related issues according to 5 CCR Section 4684(a).
  • Williams Complaint Form (DOC) (added 20-Jun-2016)
    For LEAs to make available to anyone who wants to file a complaint regarding Williams-related issues concerning deficiencies related to instructional materials, conditions of facilities that are not maintained in a clean or s
  • UCP Checklist for 2016-17 (PDF) (added 20-Jun-2016)
    Comprehensive list of required statements to be included in the six (6) different UCP policies, procedures, notices, and forms according to California Code of Regulations, Title 5 (5 CCR) sections 4600-4687.