Hopkinton Public Schools Restraint Complaint Form
This form includes the elements of what the complaint must contain. It is not required that this form be used to file a complaint.
Date:
This complaint is filed by (check one): ☐ Parent of the child ☐ Student ☐ Legal Guardian ☐ Other, please explain:. Name of complainant: Address: Preferred Phone Number: |
If this complaint is filed on behalf of a specific child, please indicate the information below: Child’s name: Child’s address: School the student attends: |
Name of school that the child was attending when the alleged violation occurred:
Name of School Principal:
Address of School:
City:
State:
Zip Code:
Statement of Alleged Violation of the Use of Restraints
This Complaint includes a violation of the Hopkinton Public School Districts Restraint Policy aligned to 603 CMR 46.
☐ Yes ☐ No ☐ Don’t Know
Please describe:
a) The date the violation began (Cannot be more than one year prior to the date this complaint is filed): b) The violation (statement that an employee has violated a requirement regarding the use of restraint):
c) Identify the portion of the statute, policy, or procedure alleged to have been violated, if known (attach additional pages if necessary):
Please describe any other background information and facts on which the complaint is based.
Complete the below information and submit to:
Print Name: |
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Signature: |
Date : |
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Print Name: |
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Signature: |
Date : |
School Committee Policies
- A - Foundations and Basic Commitments
- B - School Board Governance and Operations
- C - General School Administration
- D - Fiscal Management
- E - Support Services
- F - Facilities Development
- G - Personnel
- H - Negotiations
- I - Instructional Program
- J - Students
- K - School-Community Relations
- L - Education Agency Relations