Affirmative Action Complaint Form

NOTE: If your complaint does not involve discrimination, harassment, or retaliation based on one of these protected classes above, we kindly ask that you do not proceed with this form. Instead, please contact your school or office's designated personnel department, depending on the nature of your concern.
How has this incident affected you? (Please describe the emotional, academic, professional, or personal impact of this incident in as much detail as you are comfortable sharing.)
Have you taken any steps to address the situation? (Please describe any actions you have taken, such as speaking to your supervisor, administrator, teacher, etc.)
What outcome or resolution are you seeking? (Please describe what you would like to see happen as a result of this complaint. Please note any disciplinary action will be determined following a thorough investigation.)
Have you ever filed a similar complaint? (If yes, please provide details.)
Is there any other information you would like to provide? (Please include any other relevant details that may assist in resolving this complaint.)
Are there any supporting documents or evidence you would like to submit? (Please attach any relevant documents, such as emails, screenshots, or reports when you submit this form to the Affirmative Action Officer.)
Acknowledgment
To investigate your complaint, it will be necessary to interview you, the alleged accused, and any witnesses with knowledge of the allegations. The AAO will notify all persons involved in the investigation that it is confidential and that unauthorized disclosure of information concerning the investigation could result in disciplinary action. By signing below, you acknowledge that the information provided is true and accurate to the best of your knowledge.
Print Name:
Date:

MonthDayYear
Date
Signature:
DISTRICT POLICY AND STATE LAW PROHIBITS RETALIATION AGAINST ALL PARTICIPANTS
Should be Empty:

NOTICE OF HARASSMENT / DISCRIMINATION COMPLAINT FORM

GRIEVANT / COMPLAINANT INFORMATION

DETAILS OF THE INCIDENT

RESPONDENT INFORMATION

Acknowledgment