Your Contact Information

First Name*

Last Name*

Phone Number*

Email

Student Information

Student name or student ID*

Grade*

Gender*

Please SelectFemaleMaleOtherI prefer not to answer

Ethnicity (How do you identify?) *

Please SelectAmerican Indian, Alaska Native, Aleut, EskimoAsian/Asian AmericanAfrican AmericanAfrican/BlackCaucasian/European American/WhiteHispanic/LatinoOtherI prefer not to answer

Student's school*

Please SelectNot ApplicableAdams ElementaryJane Addams Middle SchoolAlki ElementaryArbor Heights ElementaryDaniel Bagley ElementaryBallard High SchoolBeacon Hill International ElementaryCatharine Blaine K-8Louisa Boren STEM K-8Broadview-Thomson K-8Bryant ElementaryCascade Parent Partnership ProgramCascadia ElementaryThe Center School High SchoolCleveland STEM High SchoolFrantz Coe ElementaryConcord International ElementaryB.F. Day ElementaryDearborn Park International ElementaryDenny International Middle SchoolDunlap ElementaryEckstein Middle SchoolEmerson ElementaryFairmount Park ElementaryFranklin High SchoolGarfield High SchoolGatewood ElementaryBailey Gatzert ElementaryGenesee Hill ElementaryGraham Hill ElementaryGreen Lake ElementaryGreenwood ElementaryNathan Hale High SchoolHamilton International Middle SchoolHawthorne ElementaryJohn Hay ElementaryHighland Park ElementaryIngraham High SchoolInteragency ProgramsKimball ElementaryAki Kurose Middle SchoolLafayette ElementaryLaurelhurst ElementaryLawton ElementaryLeschi ElementaryLicton Springs K-8Lowell ElementaryLoyal Heights ElementaryWing Luke ElementaryMadison Middle SchoolMadrona K-8Maple ElementaryThurgood Marshall ElementaryMcClure Middle SchoolMcDonald International ElementaryMcGilvra ElementaryMercer Middle SchoolMiddle College High SchoolMartin Luther King, Jr. ElementaryMontlake ElementaryJohn Muir ElementaryNorth Beach ElementaryNorthgate ElementaryNova High SchoolOlympic Hills ElementaryOlympic View ElementaryOrca K-8Pathfinder K-8Queen Anne ElementaryRainier Beach High SchoolRainier View ElementaryJohn Rogers ElementaryRoosevelt High SchoolRoxhill ElementarySacajawea ElementarySalmon Bay K-8Sand Point ElementarySanislo ElementaryChief Sealth High SchoolSeattle World SchoolSkills Center High SchoolSouth Lake High SchoolSouth Shore K-8John Stanford International ElementaryStevens ElementaryThornton CreekTOPS K-8Van Asselt ElementaryView Ridge ElementaryViewlands ElementaryWashington Middle SchoolWedgwood ElementaryWest Seattle ElementaryWest Seattle High SchoolWest Woodland ElementaryWhitman Middle SchoolWhittier ElementaryHazel Wolf K-8

How are you related to the student?* Parent or guardian Self Other

If you selected other, please describe your relationship to the student below

What is your concern or question?

Please select the topic that best describes your concern or question.*

Please Select504/ADADiscriminationHarassment, Intimidation, or BullyingSpecial Education ServicesAcademic ProgressAdvanced LearningAthleticsAttendanceClass Room ManagementCultural CompetencyCustomer ServiceStudent DisciplineEnrollment, School Choice, or TransferFacilitiesHigh School GraduationParent InvolvementPolicy or ProcessStudent SafetyTransportationOther

Have you spoken with the person with who you have this concern or question?*Yes No

If your answer is no, please include the reason you choose not to speak directly with the person in your description of the concern below.

Have you spoken with the principal or if a district department have you spoke with the supervisor regarding your concern or question? *Yes No

If your answer is no, please include the reason you choose not to speak directly with the person's supervisor or the school principal in your description of the concern below.

If you spoke to the person directly and or the supervisor/principal how would you rate their overall customer service? 0 - 5 (0 = poor; 5 = excellent)0 1 2 3 4 5

Briefly describe your main concern or question.*

What would you like to see happen next to resolve your main concern outlined above?*

By checking the box below, I affirm that I am submitting this information in good faith and that I am reaching out for assistance with getting an answer to my question or concern. I give permission for the information I provided to be shared with other Seattle Public Schools employees who could potentially assist with answering my question or resolving my concern.

Please keep in mind that if you say no you limit the potential of getting your question answered or problem resolved in a timely manner or at all.*Yes No Not at this time

If you selected “not at this time” and would like to explain OR if you would like to share anything additional that isn’t captured in the questions above please add that info here.

Referral

How did you hear about the Seattle Public Schools Ombudsperson or who referred you to the ombudsperson?*