CIF Los Angeles City Section

8401 Arleta Avenue, Sun Valley, CA 91352

Phone (818) 767-0800 Fax (818) 767-0802

Complaint Form

Please print and complete this form in as much detail as possible. If you have already received a decision from the school regarding your complaint, please read the information about the procedures to be followed when appealing a decision to the Section Commissioner, Appeal Committee or State CIF.

1. Name of Complaining Party: / 2. Date:
3. Complaining Party is a (check one): □ City Section school employee □ Student/Parent/Guardian
□ Non-City Section school employee □ Other (please describe): ______
4. Complaining Party’s Address (include street address, city, state, and zip code): / 5. Telephone Number:
6. Name of Involved School(s): / 7. School Principal(s):
8. School Address(es): / 9. School Athletic Director(s):
10.  Th10. This Request is for (please check one and fill in required information):
□ a complaint to the School Principal/Athletic Director
□ an appeal before the Section Commissioner
Date received decision from school about complaint: ______
□ an appeal before the BOM Appeals Committee
Date received decision from school about complaint: ______
Date received decision from Rules Committee about complaint: ______
11. What is your concern/complaint? Please identify in detail the allegation(s) or rule violation(s) (please fill out an additional form and attach if there are additional allegations):
Alleged violation 1:
Alleged violation 2:
Alleged violation 3:
12. Date(s) the violation(s) occurred (if you are complaining about more than one alleged violation, please specify which date corresponds to which allegation):
13. Names of individuals who committed the alleged violation(s), if applicable (if you are complaining about more than one alleged violation, please specify which individual corresponds to which allegation):
14. Name of school(s) who committed alleged violation (if you are complaining about more than one alleged violation, please specify which school corresponds to which allegation):
15. Specific facts regarding the nature of the violation (if you are complaining about more than one alleged violation, please specify which facts correspond to which allegation):
16. Please list any witnesses to the alleged violation(s) (if you are complaining about more than one alleged violation, please specify which witnesses correspond to which allegation):
17. I am submitting documentation in support of my complaint (check one). □ Yes □ No
If you check “yes,” please attach copies of the documentation to this form.
18. I am submitting witness statement(s) in support of my complaint (check one). □ Yes □ No
If you check “yes,” please use FORM B for witness statements and attach originals to this form.
Please list any witnesses to the alleged violation(s) (if you are complaining about more than one alleged violation, please specify which witnesses correspond to which allegation):
19.  What remedy or resolution are you seeking? Please explain in detail.
20.  I understand that the information I have provided will be investigated as well as information that may be provided by other involved parties.
Signature of Complaining Party:

Forward to: CIF Los Angeles City Section Email to:

Section Commissioner

8401 Arleta Avenue Fax to: (818) 767-0802

Sun Valley, CA 91352

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