NAME OF | : | |
COMPLAINANT(S), | : | BEFORE THE SCHOOL |
v. | : | ETHICS COMMISSION |
OF NEW JERSEY | ||
NAME OF RESPONDENT(S) | : | SCHOOL ETHICS ACT |
__________________________ | : | COMPLAINT FORM |
I, (Name of Complainant), residing at (home address, phone number, and email address of complainant), request the School Ethics Commission to consider a complaint against the above-named Respondent(s) whose home address(es) is/are (home address of respondent(s)), whose phone number(s) is/are (phone number(s) of respondent(s)), and whose email address(es) is/are (email address(es) of respondent(s)), in accordance with the authority of the School Ethics Commission to entertain such complaints under N.J.S.A. 18A:12-21 et seq.
The facts upon which this complaint is based are as follows:
RELEVANT BACKGROUND INFORMATION
Date of occurrence:___________________.
I assert this to be a violation of: ______________________, for the following reason (s):________________________________________.
(If applicable)
I assert this to be a violation of: ______________________, for the following reason (s):_________________________________________.
Date of occurrence:___________________.
I assert this to be a violation of: ______________________, for the following reason (s):________________________________________
(If applicable)
I assert this to be a violation of: ______________________, for the following reason (s):________________________________________
Date of occurrence:___________________.
I assert this to be a violation of: ______________________, for the following reason (s):________________________________________
(If applicable)
I assert this to be a violation of: ______________________, for the following reason(s):
WHEREFORE, I, as Complainant, request that the School Ethics Commission find and determine that the above-named Respondent(s) has violated the School Ethics Act and that Respondent(s) be subject to such penalty as provided by the Act.
Date: _____________________________ | _____________________________ |
Signature of Complainant or the Complainant's Attorney |
CERTIFICATION
(Name of Complainant), of full age, hereby certifies that the following statements are true:
Date: _____________________________ | _____________________________ |
Signature of Complainant |
N.J. Admin. Code § 6A:28-6.3