6:260-E1- Curriculum Objection

Please complete this form and return it to the Building Principal who will submit it to the District Complaint Manager. Please print.

Subject area:  _________________________________________________

Classroom teacher:  ______________________________

Please state, as precisely as possible, the specific curriculum area or program to which the user objects.

How did you become aware of the curriculum area or program?

_____by classroom observation           _____by review

_____by word-of-mouth                      _____ other   ______________________

To what in the curriculum area or program do you object? Be specific.

Do you want your child excluded from participation?       _____Yes          _____ No

In place of participation in the curriculum area, w hat course of study would you recommend for your child?

Complaintant name (please print):  ______________________________________

Telephone:  ___________________________________

Complaintant represents:     _____ Student          _____ Parent/guardian of student

_____ Other _________________________________

Complaintant Address: _______________________________________________________________

Signature of Complaintant: __________________________________________________________

Date:  ___________________________________

Date Approved:  4/10/2007