El dorado union high school district

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EL DORADO UNION HIGH SCHOOL DISTRICT

Williams Uniform Complaint Form

Only the issues listed below may be the subject of filing complaints concerning deficiencies in instructional materials, teacher vacancy or misassignment, and maintenance of facilities. If you wish to complain about an issue not specified below, please use the appropriate district complaint procedure. This complaint may be filed anonymously but must be dated.

Response Requested: Yes No I would like to remain anonymous.				PLEASE FILE THIS COMPLAINT WITH THE APPROPRIATE SCHOOL BELOW:
I. COMPLAINANT INFORMATION (if response required) NAME (LAST – FIRST – MI) (MR – MRS – MS)				Attn: Principal Matt Barnes EL DORADO HIGH SCHOOL VISTA HIGH SCHOOL 561 Canal Street Placerville, CA 95667 (530) 622-3634 Attn: Director, Alt. Ed. Alison Gennai INDEPENDENCE HIGH SCHOOL COMMUNITY DAY SCHOOL 385 Pleasant Valley Road Diamond Springs, CA 95619 (530) 622-7090 Attn: Principal Paul Burke OAK RIDGE HIGH SCHOOL 1120 Harvard Way El Dorado Hills, CA 95762 (916) 933-6980 or (530) 677-4402 Attn: Principal Lisa Garrett PONDEROSA HIGH SCHOOL 3661 Ponderosa Road Shingle Springs, CA 95682 (530) 677-2281 Attn: Director, Alt. Ed. Aaron Palm EDUHSD VIRTUAL ACADEMY @SHENANDOAH HIGH SCHOOL 6540 Koki Lane El Dorado, CA 95623 (530) 622-6212 Attn: Principal Tony DeVille UNION MINE HIGH SCHOOL 6530 Koki Lane El Dorado, CA 95623 (530) 621-4003 Attn: Principal Jennifer Myers MOUNTAIN VIEW HIGH SCHOOL 6530 Koki Lane El Dorado, CA 95623 (530) 621-4003 _______________________________ OR YOU MAY FILE DIRECTLY TO: DISTRICT OFFICE Attn: Steve Wehr, Asst. Superintendent Uniform Complaint Procedure Coordinator 4675 Missouri Flat Road Placerville, CA 95667 (530) 622-5081, ext. 7214
ADDRESS (ST – APT – CITY – STATE –ZIP)
HOME PHONE DAYEVENING		WORK PHONE
E-MAIL, IF ANY		CELL PHONE
II. ISSUE(S) OF THE COMPLAINT (check all that apply) A. Textbooks, instructional materials, exit exam: (Education Code 35186; 5 CCR 4681) A student, including an English learner, does not have standards-aligned textbooks or instructional materials or state- or district-adopted textbooks or other required instructional materials to use in class. A student does not have access to textbooks/instructional materials to use at home or after school. This does not require two sets of textbooks or instructional materials for each student. Textbooks or instructional materials are in poor or unusable condition, have missing pages, or are unreadable due to damage. A student was provided photocopied sheets from only a portion of a textbook or instructional materials to address a shortage of textbooks or instructional materials. List the specific nature of the deficiency(ies): The title of the course or grade level in which the deficiency(ies) in instructional materials exist: The name of the teacher of the course or grade level: B. Teacher vacancy or misassignment: (Education Code 35186; 5 CCR 4682) 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 school 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 the entire semester. A teacher lacks credentials or training to teach English learners is assigned to teach a class with more than 20% English learners in the class. A teacher is assigned to teach a class for which the teacher lacks subject matter competency. C. Facility conditions: (Education Code 17592.72, 35186, 35292.5; 5 CCR 4683) A condition exists that poses an emergency or urgent threat to the health or safety of students or staff including gas leaks; nonfunctioning heating, ventilation, fire sprinkler or air-conditioning systems; electrical power failure; major sewer line stoppage; major pest or vermin infestation; broken windows or exterior doors/gates that will not lock and that pose a security risk; abatement of hazardous materials previously undiscovered that pose an immediate threat to students or staff; structural damage creating a hazardous or uninhabitable condition and any other condition deemed appropriate by the district. A school restroom has not been cleaned or maintained regularly, is not fully operational, or 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. This does not apply when temporary closing of the restroom is necessary for pupil safety or to make repairs.
Date problem observed:	School that is subject of this complaint:		Room No. or Name of Room and/or Location of Complaint:

Williams Uniform Complaint Form
Complaint Comment (continued)
[USE THIS PAGE FOR HANDWRITTEN COMPLAINT. USE NEXT PAGE FOR CONTINUATION OF COMPLAINT OR FOR TYPEWRITTEN COMPLAINT.]

Please describe the issue of your complaint (based on issues described on page 1, section II of this form), in detail, including the date of the problem and specific location where the problem occurred (school, room number). For complaints regarding facilities conditions, please describe the emergency or urgent facilities condition and how the condition poses a threat to the health or safety of students or staff. You may attach additional pages if necessary to fully describe the situation. This complaint must be filed with the principal or designee at the appropriate address on page 1 of this complaint.

X Date:

Please provide a signature above. If you wish to remain anonymous, a signature is not required. However, all complaints, even an anonymous one, should be dated.

NOTE: COMPLAINTS FILED AT THE SCHOOL SITE WILL BE FORWARDED WITHIN 10 DAYS TO THE DISTRICT OFFICE.
Williams Uniform Complaint Form
Complaint Comment (continued)
Please describe the issue of your complaint (based on issues described on page 1, section II of this form), in detail, including the date of the problem and specific location where the problem occurred (school, room number). For complaints regarding facilities conditions, please describe the emergency or urgent facilities condition and how the condition poses a threat to the health or safety of students or staff. You may attach additional pages if necessary to fully describe the situation. This complaint must be filed with the principal or designee at the appropriate address on page 1 of this complaint.

X

Signature Date
Please provide a signature above. If you wish to remain anonymous, a signature is not required. However, all complaints, even an anonymous one, should be dated.
NOTE: COMPLAINTS FILED AT THE SCHOOL SITE WILL BE FORWARDED WITHIN 10 DAYS TO THE DISTRICT OFFICE.

F1312.4A 1/9/08; Rev. 3/9/15

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