JCS-Pine Valley Charter School Complaint Form

Complaint Procedures: In order to submit a complaint, complete the Charter School Complaint Form and submit the form to the charter school authorizer, electronically or in hard copy, to the following location:

Mountain Empire Unified School District

3291 Buckman Springs Rd

Pine Valley, CA 91962

Superintendent

Mr. Patrick Keeley

Patrick.keeley@meusd.k12.ca.us

619-473-9022

If you have questions about completing this form, please contact the Charter Schools Division by phone at 916-322-6029 or via email at charters@cde.ca.gov.

Information for Parents: Please review the information on the Charter School Complaint Notice web page at https://www.cde.ca.gov/ sp/ch/cscomplaint.asp for information on how to obtain the correct form from your charter school.

Name:	Email Address:
Mailing Address:
Date of Problem:	Phone Number:

Charter School (include address):

California Education Code (EC) Section 47605(d)(4) allows a parent or guardian to submit a complaint to the charter school authorizer when a charter school discourages a pupil's enrollment, requires records before enrollment, or encourages a pupil to disenroll. Please identify the basis for this complaint below, with specific facts, which support your complaint.

Basis of complaint (check all that apply):

Pupil was discouraged from enrolling or seeking to enroll in the charter school.

Records were requested to be submitted to the charter school before enrollment.

Pupil was encouraged to disenroll from the charter school or transfer to another school.

Please provide further details:

Please file this complaint with the authorizer of the charter school listed on the preceding page electronically or in hard copy.