TITLE IX COMPLAINT FORM
The District complies with the Civil Rights Laws, including but not limited to Title IX of the Education Amendments of 1972. It is the express policy of the board of education to encourage student or employee victims of sexual harassment to come forward with such claims. Individuals who feel that administrators, supervisors, support personnel, teachers, or students are subjecting them to sexual harassment are encouraged to report these conditions, or have their parent/guardian report these conditions to the Title IX Coordinators or the Santa Fe South Governance Board. Any employee to whom such a report was made will provide notice of the report to the Superintendent. Title IX complaints can be submitted by emailing any of the Title IX Coordinators, the Santa Fe South Governance Board or by submitting this form. Title IX Coordinators: Superintendent of Schools, Chris Brewster; Assistant Superintendent, Brooks Levonitis; Director of Counseling, Lisa SouzaTitle IX email: titleix@santafesouth.org; Santa Fe South Governance Board email: board@santafesouth.org
Please select who you would prefer to submit your complaint to from the options below.
Please Select
Superintendent
SFS Governance Board
Director of Human Resources
Name of Complainant / Nombre de quien presenta la queja*
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Address of Complainant / Dirección de quien presenta la queja*
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Phone Number of Complainant / Número de teléfono de quien presenta la queja*
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Email of Complainant / Correo electrónico de quien presenta la queja
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School / Escuela*
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Student or Employee's First and Last Name or Student ID / Número de Identificación Estudiantil*
Type of Complaint / Tipo de Queja*
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Sexual Harassment / Acoso Sexual
Sexual Assault / Agresión Sexual
Gender Based Harassment / Acoso de Género
Dating Violence / Violencia en el Noviazgo
Stalking / Acecho
Retaliation / Venganza
Cyber Bullying / Burlas cibernéticas
Other / Otro
Date Incident Occurred / Fecha en la que ocurrió el incidente. *Include earliest and latest date and/or if the action has been continuing / Incluya la fecha más temprana y más reciente del incidente y/o si la acción ha continuado
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Respondent Information / Información del Acusado. Please list the individual(s) alleged to have engaged in sexual harassment or prohibited conduct / Enumere a las personas que presuntamente han participado en acoso sexual o conducta prohibida:
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Respondent(s) name & school/department / Nombre del acusado y escuela/departamento. *Include ALL individual(s) involved / Incluya a TODAS las personas involucradas
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Nature of Complaint: Please specifically describe your complaint against the named person(s) in the previous section, including how the person(s) sexually harassed you, assaulted you, or retaliated against you. Please describe the behavior, comments, or incidents that caused you to file your complaint. (Identify: Who, What, When, and Where) / Naturaleza de la queja: Describa específicamente su queja contra las personas mencionadas en la sección anterior, incluida la forma en que las personas lo acosaron sexualmente, lo agredieron o tomaron venganzas contra usted. Describa el comportamiento, los comentarios o los incidentes que lo motivaron a presentar su queja. (Identificar: quién, qué, cuándo y dónde)*
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Identify any witnesses to the incident(s) or those who have knowledge of the incident(s) / Identifique a los testigos del incidente o aquellos que tengan conocimiento del incidente. *For each witness add: name, phone number, email, and relationship to you / Para cada testigo, agregue: nombre, número de teléfono, correo electrónico y relación con usted.
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Did you discuss this matter with any of the witnesses previously identified? If so, provide the name, date, and method of communication. / ¿Discutió este asunto con alguno de los testigos previamente identificados? Si es así, proporcione el nombre, la fecha y el método de comunicación.
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Please identify any Santa Fe South administrators, employees, or law enforcement agency to whom you have reported your concerns. / Identifique a los administradores, empleados de Santa Fe South o agencias de cumplimiento de la ley a quienes haya informado sus inquietudes.*
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Electronic Signature / Firma Electrónica- Please type your name in the following space / Por favor, escriba su nombre en el espacio a continuación. *By submitting this electronic complaint form you attest that the information you have provided above is correct and accurate. / Al enviar este formulario de queja electrónico, usted da fe de que la información que ha proporcionado anteriormente es correcta y precisa.
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