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Title IX Formal Complaint and Request for Investigation

Please complete the form below. Required fields marked with an asterisk *

I have received a copy of the District’s formal complaint procedures and agree that they have been explained to me. I am requesting a formal investigation into sexual harassment be conducted.

*If parent/guardian is not Complainant, a signature is necessary due to the Family Educational Rights and Privacy Act in order to provide consent to discuss the student with other parties and to comply with the Title IX regulations requiring the sharing of evidence with the other parties.

Date:*

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School:*

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Name of Complainant:*

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Home Address:*

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Home Phone Number:*

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Date(s) of alleged sexual harassment:*

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Name of alleged harasser (if known):*

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If name not known, description of harasser:*

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Where the harassment occurred:*

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Provide details of the harassment:*

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Witnesses to the harassment:*

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Please print your name:*

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