Mt. Diablo USD
Exhibit
Uniform Complaint Procedures

E 1312.3 
Community Relations

MT. DIABLO UNIFIED SCHOOL DISTRICT
UNIFORM COMPLAINT FORM

Date Received:	

Date Contacted Complainant:	

Date Notified of Resolution:	

Direct to appropriate Uniform Complaint Officer:

Executive Director, Instructional Support
1936 Carlotta Drive
Concord, CA  94519

NAME: ______________________________________   PHONE: ____________________

ADDRESS:_________________________________________________________________

SCHOOL/PROGRAM: ____________________________   DATE: ___________________

In the space provided below, please indicate the nature of the problem.  Please be as specific as possible.

Have you discussed the problem with a staff member or administrator?  If so, what was the outcome of your discussion?

Indicate below your recommendations for resolving the problem.

version:  August 12, 2008	Concord, California
revised: 			Concord, California