Your name
Contact details
Pupil’s name and class (if relevant)
Your relationship to the pupil (if relevant)
Contact details (e.g. address, phone number and/or email)
Please give details of your complaint, including if you have spoken to anybody in school about it.
What actions do you feel might resolve the problem at this stage?
Are you attaching any paperwork? If so, please give details
Signature and date	Date:

For school use

Acknowledgement sent by who and date.	Date:
Complaint referred to	Date: