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Lanier MS SDMC Agenda Request Form
You will receive a response to your concern as soon as possible. Concerns involving individual students,
teachers, or other staff members should follow the established administrative channels of communication.
To: SDMC Committee
Date: _________________________
From: (Name) ________________________________________________________________________
Check:
Community Member
For Parent:
Faculty/Staff
PTO/PTA
Parent
Name of child(ren) attending this school___________________________________
Do you want to appear in person to present this matter to the SDMC?
Yes
No
Description of concern or issue:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Recommendation:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Action Taken:
Placed on SDMC agenda on
Referred to Committee on
Resolved by Committee on
Final Resolution on
_____________________________________
_____________________________________
_____________________________________
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Final Resolution:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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_____________________________________________________________________________________
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See the top of this form to submit it by email or to print the form so that it can be faxed or mailed.