• Please type or print clearly in ink.
• Provide all requested information and any available documents or evidence supporting your claim, such as medical records or bills, photographs, or receipts for property damage.
• If the requested information cannot be supplied in the space provided, please use additional pages so your claim form can be easily read and understood.
• The following are examples on how to complete the Standard Tort Claim Form (Number 131-B:
• Doe, Jane Ann
• 1234 18th Ave. S., Apt. 123, Federal Way, WA 98003
• PO Box 123, Federal Way, WA 98003
• Same (or residence at the time of incident)
• (253)123-4567
• jdoe@yahoo.com or not applicable
• August 9, 2010   8:00 a.m.
• If the incident that caused the damages occurred over a period of time, please provide the beginning time and the ending time in item 8.
• Washington, King County, Federal Way, name of school or site, room or space(i.e. :Gym)
• 320th, specify milepost if known, intersection of 320th and Pacific Highway
• Federal Way Public Schools
• Smith, John 1234 Campus Parkway, Apt. 123, Federal Way, WA 98003 (206)123-4567
• List all names and titles if known
• List all other witnesses having knowledge of the incident in question, with their names, addresses and telephone numbers that are not listed within items 12 and 13.  Also, include a description of their knowledge.  For example, if your sister was with you, when the alleged incident occurred, please include her name, address, telephone number and indicate she witnessed the incident.
• Please describe the incident that resulted in the injury or damages, specifically answering the questions who, what, where, when and why.
• If you or others reported this incident to law enforcement or Security personnel, please provide a copy of the report or contact information.
• Please provide all of your medical providers with their names, addresses and telephone numbers if applicable.  You will be asked to provide a medical release statement.
• Sign the Standard Tort claim form and date

Present in Person or Mail the Standard Tort Claim Form and Supporting Documents to:

Federal Way Public Schools
Attn: Office of the Superintendent
33330 8th Ave South
Federal Way, WA 98003-5433

Business Hours: Monday through Friday 8:00 a.m. to 4:30 p.m.
Closed on weekends and holidays.