Uniform Complaint Procedure
E 1312.3 Community Relations
UNIFORM COMPLAINT FORM
OFFICIAL USE ONLY
Issue #:
School/Site:
Date Issued:
Time:
Signature of Administrator:
Date Returned:
Time:
Signature of Administrator:
A complaint under the Uniform Complaint Procedures (UCP) is a written and signed statement
alleging a violation of federal or state laws governing certain educational programs. The San
Ramon Valley Unified School District (District) has the primary responsibility to ensure
compliance with applicable state and federal laws and regulations governing these educational
programs. As always, the District's Governing Board (Board) encourages early resolution of
complaints whenever possible. However, to resolve complaints which may require a more formal
process, the Board adopted the uniform system of complaint processes specified in Title 5 of the
California Code of Regulations sections 4600-4694, as applicable, and District Board Policy (BP)
and Administrative Regulation (AR) 1312.3. The District designates UCP compliance officer(s)
who receive and coordinate the investigation of complaints and ensure District compliance with
the law. UCP complaints should be submitted by mail or email to:
Compliance Officers:
Assistant Superintendent, Human Resources OR Director, Student Services
San Ramon Valley Union School District San Ramon Valley Union School District
699 Old Orchard Drive 699 Old Orchard Drive
Danville, CA 94526 Danville, CA 94526
925-552-2923 925-552-5033
[email protected] dkravitz@srvusd.net
If you are unable to put your complaint in writing, due to conditions such as a disability or
illiteracy, the District will assist you with filing the complaint. Complaints may be filed
anonymously, and will be investigated if sufficient information is provided.
Name:
Address:
Phone Number: Email address:
Role: ☐ Parent/Guardian ☐ Employee ☐ Student ☐ Other
A complaint filed on behalf of a student may only be filed by that student or that student's duly
authorized representative.
Uniform Complaint Procedure
E 1312.3 Community Relations
COMPLAINT
Date(s) of Alleged Violation(s):
School/Dept. of Alleged Violation(s):
Basis for Complaint (select all that apply):
☐ Adult education
☐ After school education and safety programs
☐ Agricultural career technical education
☐ Career technical/technical education/technical training
☐ Child care and development programs
☐ Compensatory education
☐ Consolidated categorical aid programs
☐ Every Student Succeeds Act (ESSA)
☐ Migrant education
☐ Regional Occupation Centers and Programs (ROCP)
☐ School safety plans
☐ Sexual Harassment (BP 5147.7)
☐ Discrimination, including harassment, intimidation, or bullying, on the basis of (select
all that apply):
☐ Race ☐ National origin ☐ Sex
☐ Ethnicity ☐ Age ☐ Gender
☐ Color ☐ Religion ☐ Gender identity
☐ Ancestry ☐ Marital status ☐ Parental status
☐ Gender expression ☐ Sexual orientation ☐ Genes
☐ Ethnic group identification ☐ Physical or mental disability
☐ Association with person/group with one or more of these actual or perceived characteristics
☐ Reasonable accommodations to a lactating student
☐ Pregnant or parenting student
☐ Pupil fees
☐ Local Control and Accountability Plans (LCAP)
☐ School plan for student achievement
☐ School Site Council
☐ Educational rights for foster youth
☐ Educational and graduation requirements for foster youth, homeless youth, and other
youth (e.g., former juvenile court school pupils, children of military families, newcomers
and migratory education students)
☐ Courses of study without educational content
☐ Deficiencies related to preschool health & safety issues for a California state preschool
☐ Physical education instructional minutes
☐ Retaliation
Uniform Complaint Procedure
E 1312.3 Community Relations
☐ Any other state/federal program the Superintendent of Public Instruction deems
appropriate
DESCRIPTION OF COMPLAINT
Please describe your complaint in detail, including the date(s), name(s) of people involved in the
complaint, and the results of any previous meetings or discussions with the site or personnel
regarding the complaint. You may attach additional pages as necessary to fully describe your
complaint.
✎ I understand that the site administrator, Superintendent or
designee, or Board may request from me further information about this complaint and, if such
information is available, I shall present it upon request.
I, hereby certify that the above statements are true and correct
to the best of my knowledge.
Signature:_____________________________________ Date:___________
272-7/6142497.1
