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PURPOSE: The purpose of this Title IX grievance form is to gather the essential basic facts of the alleged actions in order that, prompt and equitable resolutions of complaints based on sex discrimination, including complaints of sexual harassment or sexual violence, in violation of Title IX of the Education Amendments of 1972 (“Title IX”) can be resolved as expediently and appropriately as possible. This form only applies to complaints alleging discrimination prohibited by Title IX (including sexual harassment and sexual violence).
 
Review Criteria for Title IX Violations
 
INSTRUCTIONS: Individuals alleging Title IX discrimination and requesting review are required to complete this form. It will be submitted to the Title IX Coordinator immediately and will be reviewed as soon as possible after the occurrence of the alleged discrimination.
 
Student Grade:Question is mandatory
Are there any witnesses to this matter?Question is mandatory
Did you discuss this matter with any of the witnesses identified in Item 5?Question is mandatory
Have you spoken to any administrator(s) or other school employee(s) about this matter?Question is mandatory
PLEASE ATTACH ANY STATEMENTS, NAMES OF WITNESSES, REPORTS, OR OTHER DOCUMENTS WHICH YOU FEEL ARE RELEVANT TO YOUR COMPLAINT.
 

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