Harassment Complaint Form

INDEPENDENT SCHOOL DISTRICT NO. 709 HARASSMENT COMPLAINT FORM
Name of Person Filing Complaint (Complainant)
Address
Telephone
StudentEmployeeParentOther
SexualGeneralProtected Group
RaceColorCreedReligionNational OriginSexAgeMarital StatusDisabilityPublic AssistanceSexual OrientationGender Identity/ExpressionOther
Name of Person You Are Reporting (Respondent)
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
Date

MonthDayYear
Date
Should be Empty:

INDEPENDENT SCHOOL DISTRICT NO. 709 HARASSMENT COMPLAINT FORM