Title IX Formal Complaint

Date

(MM/DD/YYYY)

Complainant Name: Question is mandatory

Address:

Street

City

State

Zip

Email(Optional)

Telephone:

Home

Work

Respondent Name:

(person whom complaint is against)

Describe the alleged sexual harassment in specific terms (attach additional pages if necessary). Include:
The specific incident or activity that is alleged to be in violation of Title IX;
The name of all individuals involved; and
All dates, times, and locations involved.

Describe any relevant communication that has already occurred to address the issue. Please specify the types of communication, dates of communication, and names of individuals with whom any communication has occurred.

Do you want this Complaint to be formally investigated and addressed by the District?

Yes

Signature of Complainant

Date Signed

(MM/DD/YYYY)

PLEASE RETURN THIS FORM TO THE TITLE IX COORDINATOR LISTED ON THIS FORM