Ombudsman Intake Form

Ombudsman's Office

First Name *

Last Name *

Person completing the form *

Phone Number *

E-Mail

Student Name *

School Name *

Student ID# *

Student Grade Level *

What is this in reference to? *

Concern *

Briefly describe your concern (in 250 words or less)

Actions Taken *

What have you already done to try to resolve the problem?

Remedy Requested *

Attachments

Untitled 1

P.O. Box 30035
Charlotte, NC 28230-0035
Phone: 980-343-3000

The Charlotte-Mecklenburg Schools website (www.cms.k12.nc.us) is in compliance with Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act. Any website accessibility concerns may be brought via the following, Email the Web Accessibility Team at WebAccessibility or Call: 980.343.0115. In compliance with Federal Law, Charlotte-Mecklenburg Schools administers all education programs, employment activities and admissions without discrimination against any person on the basis of gender, race, color, religion, national origin, age, or disability. Inquiries regarding compliance with Title IX of the Education Amendments of 1972, which prohibits discrimination on the basis of sex in education programs or activities, may be referred to the District's Title IX Coordinator at titleixcoordinator or to the Office for Civil Rights, United States Department of Education.