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Policy Appendix C: Complaint Form Template

To file a formal complaint, this form must first be completed in its entirety and is to be submitted to the Board Chair or Vice as per Policy 4 - Trustee Code of Conduct.

Complainant’s Name: _____________________________

Contact Number: ________________________________

E-mail: ________________________________________

Address: _______________________________________


Complaint Details 

Summarize the nature of your complaint including which section of the Code of Conduct was allegedly breached: 

Have you attempted to resolve your complaint informally? List any steps you have taken to try and resolve your complaint, in addition to identifying relevant dates and who you have dealt with: 

Other- Please use this section if you have any additional information that you wish to share, or if you wish to attach any documentation. 


Complainant’s signature 




Receipt acknowledgement date


Board Chair’s signature

Personal information is collected for the purpose of assessing complaints. Information collected will be used for investigative and non-investigative purposes. Collection is authorized under section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act and is managed and protected in accordance with the Act. Questions about the collection and use of information can be directed to the Superintendent Designate.