Improper Data Disclosure Reporting Form
The Churchville-Chili Central School District takes security of student data seriously. If you believe there has been a possible breach or improper disclosure of student data, please complete this form and submit it online or print out the form and mail it to the district Data Privacy Officer. Churchville-Chili Central School District, 139 Fairbanks Road, Chruchville, NY 14428.
Phone Number of Reporter:
Email Address of Reporter:
Date the violation occurred:
Name(s) of person involved
Description of data compromised:
Description of the improper disclosure or data breach:
Any additional information relevant to the incident: