Report an Improper Disclosure

Report an Improper Disclosure

CVSCS Unauthorized Disclosure Complaint Form


Parents, eligible students (students who are at least 18 years of age), principals, teachers, and employees of an educational agency may file a complaint about a possible breach or improper disclosure of student data and/or protected teacher or principal data using this form. This form will be submitted to the Superintendent/DPO. Please do NOT include any information in this form that would constitute student personally identifiable information.

After submitting the form, the DPO will promptly acknowledge receipt of the report within 24 hours.


When the fact finding process is complete, the DPO will provide the reporting party with the findings made at the conclusion of the fact finding process; this should occur no later than 60 days after the receipt of the initial report, and, if additional time is needed the report shall be given a written explanation within the 60 days that includes the approximate date when the findings will be available.


Please note that the CVSCS DPO shall maintain a record of each report received of a possible Breach or Unauthorized Disclosure, the steps taken to investigate the report, and the findings resulting from the investigation in accordance with applicable record retention policies.


First Name
Last Name
Phone Number
Email Address
Role/Relationship to Student
District/Building Affiliation
Description of Event(s):
Description of Possible Disclosed Data:
Description of How Reporter Learned of Possible Disclosure:

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