Report an Unauthorized Data Disclosure

*Please note, required fields are in red.

A report of unauthorized data disclosure can be submitted by a parent/guardian or parents/guardians of a student, an eligible student (a student who is at least 18 years of age or attending a postsecondary institution at any age), principals, teachers, and employees of an educational agency. Please limit the amount of personally identifiable information shared when completing this form.

Contact Information

1. Last Name

2. First Name

3. Email Address

4. Phone Number

5. Please select the role that best represents the person submitting the form

Parent/Guardian

Student

Teacher

Principal

Superintendent

Educational Agency Employee

Provide details of the unauthorized disclosure here

6. Please enter the date when the unauthorized disclosure occurred or was discovered

Open the calendar popup.

7. Please share what parties were impacted by the disclosure

8. Describe what data was disclosed to the best of your ability. Separate data types by a semicolon. (Example: Demographic data; Health data; Ethnicity data)

Add any additional information you feel is relevant here

Send me a copy?

Report an Unauthorized Data Disclosure

Contact Information

Provide details of the unauthorized disclosure here

Virtual Resources

Library Resources

Contact Information