Public and Nonpublic

Elementary and Secondary School

Pesticide Neighbor Notification

Complaint Form

(please print)

INSTRUCTIONS: This form is to be used to file complaints relating to public or nonpublic elementary or secondary schools pursuant to alleged noncompliance with section 409-h of the State Education Law (Pesticide Neighbor Notification Law). Information provided on this form will be used to investigate the school's compliance with section 409-h. Please provide detailed facts relative to your complaint. Please attach additional information as necessary.

School District or Nonpublic School Name:

Building Name & Address:

Your Name & Telephone Number:

Your Address:

 

 

Please provide a detailed description of the complaint:
 
 
 
 
 
 
 
 

Return completed form to:

Laura Sahr

New York State Education Department

Office of Facilities Planning

Room 1060 EBA

Albany, New York 12234

FAX: 518-486-5918