Discrimination, Anti-Bullying, and Anti-Harassment Complaints

Complaint Form

(Discrimination, Anti-Bullying, and Anti-Harassment)

"*" indicates required fields

Date of Complaint*

Name of Complainant*

First Last

Home Address of Complainant*

Street Address Address Line 2 City ZIP Code

Phone Number of Complainant*

Your Email Address*

Email Address Confirm Email Address

Preferred Method of Contact

Please select your role*

Are you filling out this form for yourself?*

Yes

(Please identify the individual if you are submitting on behalf of someone else)

Building where complaint should be directed (select from dropdown)*

Have you talked to the building principal or immediate supervisor to try to resolve the problem?*

Yes

If the conduct involves your principal or immediate supervisor, have you followed the chain of command and contacted that person's immediate supervisor?**

Yes

Complaint

Please provide as much detail as possible in this section.

Who or what entity do you believe discriminated against, harassed, or bullied you (or someone else)?*

Name of any witnesses (if any):

Allegation*

In the space below please describe what happened and why you believe that you or someone else has been discriminated against, harassed, or bullied. Please be as specific as possible, including listing actions you took to respond to the incidents. Attach any pertinent documents or additional pages if necessary.

File

Max. file size: 64 MB.

On what basis?*

Nature of discrimination, harassment, or bullying alleged*

(check all that apply)

If you indicated "other" above, please specify here.

When did the alleged treatment begin?*

Type Your Full Name*

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Discrimination, Anti-Bullying, and Anti-Harassment Complaints

Complaint Form

Complaint

Our District