Title IX Complaint Form

Title IX Complaint Form
Purpose: The purpose of the Title IX formal complaint process is to inform the District of allegations of sexual harassment, sexual violence and sex discrimination in violation of Title IX of the Education Amendments of 1972 ("Title IX") so that the District may take appropriate action.
Instructions: Individuals alleging Title IX sexual harassment and requesting a review are required to complete this form and submit it to the Title IX Coordinator as soon as possible after the occurrence of the alleged harassment.
Complainant Role*

StaffStudentAnonymous
Respondent Role*

StaffStudent
Complainant Information
Name*
School/Office*
Phone*
Address*
Incident Information
Name of person(s) you believe committed an offense*
Case Type*
Sub Case Type*
Location of Incident*
Date of Incident*

MonthDayYear
Date
Is this an ongoing incident?*

YesNo
Incident Details*
Were there any witnesses?*

YesNo
List name(s) of any known witnesses*
Acknowledgement
I certify the aforementioned is true and correct.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Complainant Information