How to Contact Us: Office of the Ombuds Intake Form

Thank you for sharing your concern with the Office of the Ombuds. By submitting this form, you certify that the information is true and accurate. We will contact you to learn more about your concerns, clarify any issues and discuss options.

Your Name Your Name First Last
Phone Number Phone Number - ### - ### ####
Email
Person completing this form
If you are inquiring about a concern regarding a student, please provide (if possible):
Student Name Student Name First Last
Student Grade Level
School Name
Concern (briefly describe your concern in 250 words or less)
Maximum of 250 words allowed. Currently Entered: 0 words.
Actions Taken (What have you already done to try to resolve the problem? 250 words or less)
Maximum of 250 words allowed. Currently Entered: 0 words.
Remedy Requested (250 words or less)
By checking the box below, I affirm that I am submitting this information in good faith and that I am reaching out for independent, impartial and informal assistance with getting an answer to my question or concern.

By checking the box below, I affirm that I am submitting this information in good faith and that I am reaching out for independent, impartial and informal assistance with getting an answer to my question or concern. Affirmation
Confidentiality: I give permission for the information I provided to be shared with other Frederick County Public Schools employees who could potentially assist with answering my question or resolving my concern.

Confidentiality: I give permission for the information I provided to be shared with other Frederick County Public Schools employees who could potentially assist with answering my question or resolving my concern. Yes No Not at this time

How to Contact Us: Office of the Ombuds Intake Form

How to Contact Us: Office of the Ombuds Intake Form

If you are inquiring about a concern regarding a student, please provide (if possible):