LCPS Form KE-E1:
Formal Complaint from the Public
Las Cruces Public Schools
Department of Community Relations
INSTRUCTIONS: Complete sections I and II of this form when filing a formal complaint. Within three work days after filing the complaint
with the school principal/supervisor, you will be contacted to set up a meeting to discuss the complaint. For more information, call the
LCPS Community Relations Department at 575.527.5946. Reference Policy KE: Community Concerns and Complaints.
Part I – COMPLAINTANT INFORMATION (to be completed by Complainant)
Complainant: Click
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Complainant Address: Click
Email Address:
Phone #:
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Alternate #:
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Student Name (if applicable): Click
Grade: Click
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Date, time and location where incident occurred: Click
Witness Click
PLEASE PRINT
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Witness
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School: Click
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☐ Yes ☐ No Prior to filing this Formal Complaint, I have discussed my complaint/concern with the school principal/supervisor through an
informal complaint process. If yes, describe the informal process. Click
If no, explain why not. Click
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Part II – INCIDENT INFORMATION (to be completed by Complainant)
PLEASE PRINT
Describe the incident(s) as clearly as possible, including such details as any verbal statements (i.e. threats, requests,
demands); etc. (Attach Form JICF-E3 - Addendum to LCPS Forms to this form, if necessary.)
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Action Requested: Click
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I hereby certify that the information I have provided in this complaint is true, correct and complete to the best of my knowledge and
belief.
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Date
Complainant
Date
Received by
LCPS Form KE-E1 Pg 1 (Revised from KA-E1 11.22.11; revised 07,11)
Distribution: Dept. of Community Relations, Complainant, Principal/Supervisor
LCPS Form KE-E1: Formal Complaint from the Public
(continued)
Part III – FACILITATION BY DEPARTMENT OF COMMUNITY RELATIONS (to be completed by Director of Community Relations)
☐ A copy of the complaint was forwarded to the Principal/Administrator on (date) Click
Date and location of scheduled meeting:
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Individuals contacted to attend meeting Click
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☐ Yes ☐ No Principal/Supervisor or Complainant will bring legal counsel to meeting(s).
☐ Other participants contacted
Part IV – MEETING INFORMATION (to be completed by Principal/Administrator)
Date and location of scheduled meeting:
List participants:
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Others, please explain: Click here to
Action on Complaint: Click
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Describe the final resolution or the next step(s) to a resolution: (attach Form JICF-E3 - Addendum to LCPS Forms, if necessary).
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☐ Yes ☐ No Additional Meeting
Date and location of next meeting: Click
Individuals to contact for next meeting: Click
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Date
Complainant
Date
Principal/Supervisor
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Date
Director of Community Relations
LCPS Form KE-E1 Pg 1 (Revised from KA-E1 11.22.11; revised 07,11)
Distribution: Dept. of Community Relations, Complainant, Principal/Supervisor