Pennsylvania Department of Education
PLS Private Licensed Schools   
 Complaint Information   Complaint Instructions 
In order for the State Board of Private Licensed Schools to investigate a complaint, a student must first follow the school's written policy for procedures concerning student grievances, then provide the information requested below. A COPY OF THIS COMPLAINT WILL BE SENT TO THE SCHOOL.
School Name
City                                                State    Zip Code      
School Address
Complainant's Name
Last                          First                         MI    Title
Complainant's Address
City                                                State    Zip Code      
Program Attended
Date of Attendance
From To
Telephone Numbers
Home Work
Does the school have an established policy and procedures for resolving student complaints ? (Check one)
Have you followed the school's established procedure for resolving student complaints ?(Check one)
School Official Name
Last                          First                         MI    Title
Brief summary of outcome of discussion with school official
Please clearly explain the condition(s) which caused you to file a written complaint. Try to represent the events and concerns in the order in which they occured. Please include a final paragraph in which you identify the action you seek to resolve your complaint.

Private Licensed Schools Version 1.0
Pennsylvania Department of Education, 333 Market Street, Harrisburg, PA 17126-0333
Phone: 717-783-6788
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