BOARD POLICY
#4013A
June 11, 2008
Conestoga Public Schools
104 East High Street
Murray, NE 68409
Policy BE
Complaint Form "A"
Name and Address of Person Date: _______________________
Making Complaint:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Name of Person(s) Being Complained Against: _____________________________________
_____________________________________
_____________________________________
Date of Action Causing Complaint ____________________________
Complaint: ______________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(attach another sheet if necessary)
Supportive Evidence or Witnesses: ____________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
(attach copies of materials if necessary)
________________________________________
Signature of Person Making Complaint
