PPRA Complaint Form

U.S. DEPARTMENT OF EDUCATION
Protection of Pupil Rights Amendment (PPRA)

FORM APPROVED
OMB NUMBER: 1880-0544
Exp. Date: XX/XX/XXXX

Complaint Form
Instructions: The United States Department of Education's (Department) Student Privacy Policy Office (SPPO) reviews,
investigates, and processes complaints of alleged violations of the Protection of Pupil Rights Amendment (PPRA). 20 U.S.C.
1232h; 34 CFR Part 98. PPRA is a federal law that affords certain rights to parents of students attending elementary or secondary
schools with regards to any survey, analysis, or evaluation that asks students to reveal information of a personal nature. The
rightsafforded parents under PPRA transfer to the student when the student turns 18 years old or is an emancipated minor under
applicable State law. PPRA also concerns marketing surveys, parental access to instructional material, as well as the
administration of certain physical examinations to minors. A local educational agency (LEA), or school district, must provide
parents effective notice of their rights under PPRA.
PPRA applies to the programs and activities of recipients of funds under any program funded by the U.S. Department of
Education (Department), such as LEAs. It governs the administration to students of a survey, analysis, or evaluation that concerns
one or more of the following eight protected areas:
1.

Political affiliations;

2.

Mental and psychological problems of the student or the student's family;

3.

Sex behaviors and attitudes;

4.

Illegal, antisocial, self-incriminating, or demeaning behavior;

5.

Critical appraisals of other individuals with whom respondents have close family relationships;

6.

Legally recognized privileged or analogous relationships, such as those of lawyers, physicians and ministers;

7.

Religious practices, affiliations or beliefs of the student or the student's parents; or

8.

Income (other than that required by law to determine eligibility for participation in a program or for receiving financial
assistance under such program.)

An LEA is required to obtain written consent before students are required to submit to a survey that contains one or more of the
eight protected areas listed above if the survey is funded in whole or in part by the Department. For surveys that contain
questions from one or more of the eight protected areas that are not funded in whole or in part with Department funds, an LEA
must notify parents at least annually, at the beginning of the school year, of the specific or approximate date(s) of the survey and
provide parents with an opportunity to opt their children out of participating, regardless of whether the survey is anonymous or
whether participation in the survey is voluntary. If the LEA is unable to identify the specific or approximate dates of the survey
(or other activity described below) at the beginning of the school year, it must provide this notification to parents once the activity
or survey is scheduled. Parents should be provided reasonable notification of the planned activities and surveys and be provided
an opportunity to opt their children out, as well as be provided with an opportunity to review any pertinent surveys. Please note
that PPRA does not apply to surveys administered to students in accordance with the Individuals with Disabilities Education Act.
20 U.S.C. 1400 et seq.
In addition to providing specific notification for surveys as described above, LEAs are also required to notify parents of these
activities and provide parents with an opportunity to opt their children out of participating in the following activities:
•

Activities involving the collection, disclosure or use of personal information collected from students for marketing purposes;
and

•

Any non-emergency, invasive physical examination or screening that is (1) required as a condition of attendance; (2)
administered by the school and scheduled by the school in advance; and (3) not necessary to protect the immediate health and
safety of the student, or of other students. This requirement does not apply to any physical examination or screening that is
permitted or required by State law, including physical examinations or screenings permitted without parental notification.
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LEAs must provide parents effective notice of their rights under PPRA, including the right to review, upon request, any
instructional materials used in connection with any survey that concerns one or more of the eight protected areas and those used
as part of the educational curriculum. For more information, see the model notification on our website: https://
studentprivacy.ed.gov/resources/ppra-model-general-notice-rights.
LEAs are also required to develop and adopt policies, in consultation with parents, regarding these and other rights under PPRA.
For more information, see https://studentprivacy.ed.gov/faq/what-policies-must-local-education-agency-lea-develop-underprotection-pupil-rights-amendment.
SPPO investigates written complaints alleging a violation of PPRA if the complaint: (1) is filed by a parent of a student (or a
student 18 years or older or emancipated under State law) affected by a violation of PPRA; (2) is submitted to SPPO within 180
days of the date of the alleged violation or of the date that the complainant knew or reasonably should have known of the alleged
violation; (3) contains specific allegations of fact giving reasonable cause to believe that a violation of PPRA has occurred; and
(4) contains evidence of attempted resolution at the local level (and at the State level if a State complaint resolution process
exists).
Individuals wanting to file a complaint should do so by completing this Complaint Form (available at https://
studentprivacy.ed.gov/file-a-complaint) in its entirety and submitting it electronically or by mail. If you choose to submit this
form electronically, please note that this form is a fillable PDF (Portable Document Format) and works best when used with
Adobe Reader (available for download at https://get.adobe.com/reader/.) Once you have completed the form, please type
yourname in the signature space and click “Submit Form.” Your computer's default email software program should then open
andcreate an email with the Complaint Form attached. In order to complete the submission process, you must send this
email, and attachment, as appropriate.
In the event that you have either not selected a default email software program on your computer, or the default email
software program you have selected does not open when clicking “Submit Form,” in order to complete the submission
process, you must either save the form, manually attach it to an email, and send that email to [email protected];or, print
the form, and sign and mail it to:
Student Privacy Policy Office
U.S. Department of Education
400 Maryland Avenue, SW
Washington, D.C. 20202-8520
You should receive a confirmation of SPPO's receipt of your complaint within three business days from the date of your
submission. Failure to complete the Complaint Form in its entirety or to not provide any of the information required for SPPO to
determine whether your complaint contains specific allegations of fact giving reasonable cause to believe that a violation of
PPRA has occurred, may result in, among other things, the dismissal and/or return of your complaint to you in order to obtain
additional information needed by SPPO to further consider your complaint. If your complaint is dismissed, you may choose to
resubmit a new complaint per the instructions set forth above and in accordance with the requirements of PPRA.
Also, you should be aware that when reviewing, investigating, or processing your complaint, SPPO may disclose, without
your prior, written consent and pursuant to routine uses of the records that have been published in the system of records
notice covering PPRA complaints, information contained in your complaint, such as the name of the complainant, the name
of the student if the student did not submit the complaint, and the alleged violation(s), including, but not limited, to the
educational agency or institution against which your complaint has been made.
SECTIONS 1 & 2: STUDENT AND COMPLAINANT INFORMATION
It is important that, in completing these sections, all requested information is provided regarding both the student and the
complainant including the student's correct birthdate. An attorney or advocate may file a complaint on behalf of a parent, a student
who has turned 18 years old, or an emancipated minor; however, SPPO will not discuss the complaint with the attorney or advocate
without the prior, written consent of the parent, adult student, or emancipated minor, as applicable. SPPO will dismiss anonymous
complaints and complaints filed by a party other than the parent, student who has turned 18 years old, or emancipated minor who is
the subject of the complaint, or his or her attorney or advocate.
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Please note only a parent or guardian of a student directly affected by a violation under the PPRA or a student who has turned
18 years old or an emancipated minor under State law may file a complaint.
SECTION 3: LOCAL OR STATE EDUCATIONAL AGENCY INFORMATION
This section requires that you provide, among other information, the name and address of the current superintendent of the LEA
(school district) that you are alleging violated PPRA. PPRA also applies to the programs and activities of a State educational
agency, such as a State department of education, or other recipients of funds under any program funded by the U.S. Department
of Education. For instance, private elementary and secondary schools generally do not receive funds from the Department and
are, therefore, not generally subject to PPRA. SPPO generally will dismiss complaints filed against elementary or secondary
schools that are not listed on the Department's National Center for Education Statistics Public School website (available at
https:// nces.ed.gov/ccd/schoolsearch/). Please note that it is extremely important that you enter the specific date (mm/dd/yyyy) of
the alleged violation in this section for us to accurately determine the timeliness of your complaint. As stated above, a complaint
must be filed within 180 days of the alleged violation or within 180 days after the complainant knew or reasonably should have
known of the alleged violation.
SECTION 4: PPRA VIOLATION INFORMATION
In describing the alleged violations, you must respond to all of the information requested in the heading(s) that pertain to the
nature of your complaint. Your response should only include the relevant facts that would give reasonable cause to believe that a
violation of PPRA has occurred. You must also include evidence of attempted resolution of the complaint at the local level (and
at the State level complaint resolution process exists), including the names of local and State officials contacted and significant
dates in the attempted resolution. To the greatest extent possible, please limit your response to the space provided in this
Complaint Form; if more space is needed, you may attach additional documents in which you further describe your complaint.
Failure to provide any of the required information may result in, among other things, your complaint being dismissed or returned
to you for additional clarification, which would delay the processing, and might impact the timeliness, of your complaint.
SECTION 5: CORRESPONDENCE INFORMATION
If there is any correspondence or other information, such as newspaper articles, website postings, email or letter exchanges, that
substantiates your allegations, please briefly describe it in this section. You may also attach copies of relevant documents that
support your allegations. Please note that, due to computer security concerns, SPPO will not accept the submission of audio or
video files, CD/DVDs, or thumb drives. Also, the submission of nonessential, voluminous, or nonresponsive information may,
among other things, delay the processing, or result in the dismissal or return, of your complaint.
SECTION 6: CERTIFICATION
Certify that the information you have provided in the Complaint Form is true and correct under penalty of perjury by typing
in your name in the signature space, if filing electronically, or by printing out the Complaint Form and signing it, if filing via
mail.

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U.S. DEPARTMENT OF EDUCATION
Protection of Pupil Rights Amendment (PPRA)

Parent/Student Complaint Form
SECTION 1: STUDENT INFORMATION
First Name:

Last Name:

Student Date of Birth:

SECTION 2: COMPLAINANT INFORMATION
Your relationship to the student whose education records are the subject of this complaint. (If an attorney or advocate, please note that SPPO
will not discuss the complaint with you without the prior consent of the parent or eligible student who maintains the rights under PPRA.)

Parent or Legal Guardian
Title:

Self

Other (ex. Attorney/advocate on behalf of the parent or eligible student)
Last Name:

First Name:

Street Address:

Phone Number:

City

State

Zip

By listing an email address, you are giving SPPO

Email permission to use the email address to contact you.

Name and title of the local education agency or school district superintendent:

Name of local educational agency (i.e., school district):

Phone Number:

Mailing Address:

Dates Attended:

State:

City:

Zip Code:

SECTION 4: PPRA VIOLATION INFORMATION
Specifics of alleged PPRA violation:

ED-EMVC-003.03 04/22

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Date of Alleged Violation:

If allegations concern a survey, provide the name of the survey, analysis or evaluation:

Source of funding for survey, analysis, or evaluation (if known):

Details of attempted resolution at local level:
Local School Officials Contacted

Dates

Results/Comments

Details of attempted resolution at State level (if State resolution procedure exists):
State Education Officials Contacted

ED-EMVC-003.03 04/22

Dates

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Results/Comments

SEC
ECTI
TIO
ON 5: CO
CORRE
RRESSPONDE
NDENCE
NCE INF
NFO
ORM
RMAT
ATIION
Describe any correspondence, such as newspaper articles, website postings, email or letter exchanges, that substantiates the
information specifically required in Section 4 above. You may also attach copies of those relevant documents that support your
allegations. Please note that, due to computer security concerns we will not accept the submission of audio or video files, CD/
DVDs, or thumb drives. Also, the submission of nonessential, voluminous, or nonresponsive information may, among other
things, delay the processing of your complaint, and could result in the dismissal and return of your complaint.

ON 6: CE
SEC
ECTI
TIO
CERT
RTIIFICAT
CATIION

Date:

Complainant's Signature

Privacy Act Statement. The Department is authorized to solicit the information contained in this form by 20 U.S.C. 1232h. Your disclosure of the information requested on this
Form is voluntary, but if you fail to provide any of the information, it may result in, among other things, your complaint being dismissed or returned to you for additional
clarification. The principal purpose for which the information requested on this Form will be used is to resolve your complaint and determine whether the educational agency or
institution violated PPRA. The Department has published the routine uses for which the information requested on this Form may be used in a system of records notice entitled
"Family Educational Rights and Privacy Act (FERPA) and the Protection of Pupil Rights Amendment (PPRA) Record Systems (18-05-02), which was last published in the
Federal Register on June 4, 1999 (64 Fed. Reg. 30106, 30123-24). The routine uses include, but are not limited to, disclosing records to the educational agency or institution
against which a complaint has been made or the State Educational Agency in that State. The Department may modify and update this system of records notice, in which case that
update in addition to the Department's other systems of records notices may be found at: https://www2.ed.gov/notices/ed-pia.html. The effects of not providing any of the
requested information on this Form may include, among other things, that your complaint is dismissed or returned to you for additional clarification.
Paperwork Burden Notice. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a
valid Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection is 1875-XXXX. Public reporting burden for
this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Obligation to respond is voluntary. If you have questions on your individual submission
of this form, write directly to: Student Privacy Policy Office, U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202-8520.

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ED-EMVC-003.03 04/22

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