Complainant's Name: (but you may remain anonymous)

Email address:

Mobile Number/ Landline:

Type of Concern: (Please choose one)
Complaint/ReportQueryFollow-upFeedback

Name of School:

Schools Division Office:

Region:

Learner Rights and Protection Concern: (Please select all that apply)
Physical BullyingSocial BullyingGender-based BullyingCyberbullyingSexual AbusePhysical AbusePsychological AbuseVerbal AbuseDiscriminationChild LaborCorporal PunishmentChild ExploitationChild NeglectChild-at-Risk (CAR)Children in Conflict with the Law (CICL)Online Child Sexual Abuse and ExploitationSubstance Abuse/ Drug DependencyOther Learner Rights and Protection Concerns

Other Learner Rights and Protection Concerns (not mentioned above):

Details of the Complaint/ Report

I hereby affirm my right to be informed, object to processing, access and rectify, suspend or withdraw my personal data, and be indemnified in case of damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding Implementing Rules and Regulations.

The Department of Education recognizes its responsibilities under the Republic Act No. 10173 (Act), also known as the Data Privacy Act of 2012, with respect to the data they collect, record, organize, update, use, consolidate or destruct from their personnel and clientele. The personal data obtained from this form is entered and stored within DepEd's authorized information and communications system and will only be accessed by the authorized personnel. DepEd has instituted appropriate organizational, technical and physical security measures to ensure the protection of personal data.
Furthermore, the information collected and stored in the portal shall only be used for the purposes of this complaint form. DepEd shall not disclose any personal information without their consent and shall retain this information over a period of ten years for the effective implementation and management of this form.

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