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Compass Montessori Title IX Complaint Form 2023 - 2024
Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681) is an all-encompassing federal law that prohibits discrimination based on the gender of students and employees of educational institutions which receive federal financial assistance. When the form has been completed and signed by you, and then signed by the Title IX Coordinator or a Deputy, your complaint has been properly received and noted by Jeffco Public Schools. You will automatically be provided with a copy of your response.
This form is only for people filing a complaint of their own or for parents/guardians filing on behalf of their own student.
You can find complete information about the Title IX complaint process, requirements, and timelines, at
www.compassmontessori.org/titleix
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* Indicates required question
Email
*
Your email
First & Last Name
Your answer
Phone Number
Your answer
I am filing a complaint as:
(Regardless of your choice below, this complaint will be reviewed by our Title IX Coordinator and kept confidential per the official Title IX procedures.)
Student
Staff
Parent/Guardian
Anonymous
Clear selection
First and Last Name of the subject of the complaint.
(Name of person or persons you believe committed the offense against you and how you have contact with them, such as
fellow student, supervisor, co-worker, staff member, etc
.)
Your answer
Date of alleged incident or time frame of alleged incident.
Your answer
Have you brought this matter to the attention of any other staff at the school, police, or social services? If so, please list the name(s), email address and/or phone number of all persons with whom you have discussed this matter.
Your answer
List of Witnesses to the alleged incident. Please list names and contact information of any staff or student who witnessed the incident(s).
Your answer
Where did this incident occur?
Your answer
I affirm the report above is true and correct.
(Please type full name below to acknowledge and agree that the above report is true.)
Your answer
A copy of your responses will be emailed to the address you provided.
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