Harassment Complaint Form

INDEPENDENT SCHOOL DISTRICT NO. 709 HARASSMENT COMPLAINT FORM
Name of Person Filing Complaint (Complainant)
Address
Telephone
Status of Person Filing the Complaint

StudentEmployeeParentOther
Type of Complaint

SexualGeneralProtected Group
Protected Group (If applies)

RaceColorCreedReligionNational OriginSexAgeMarital StatusDisabilityPublic AssistanceSexual OrientationGender Identity/ExpressionOther
Name of Person You Are Reporting (Respondent)
Status of Person You Are Reporting

StudentEmployeeParentOther
Statement of Complaint (Include type of harassment/violence, who was involved in the specific incidents in which it occurred, names of witnesses, etc.)
I UNDERSTAND THAT IN ACCORDANCE WITH DISTRICT POLICY #413, INDEPENDENT SCHOOL DISTRICT 709 WILL ADDRESS THIS COMPLAINT.
Signature of Complainant

Clear
Date

MonthDayYear
Date
Should be Empty:

INDEPENDENT SCHOOL DISTRICT NO. 709 HARASSMENT COMPLAINT FORM