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Title IX Appeals Request Form
Weld County School District Re-5J
Brandi Trevino
-
Title IX Coordinator/Compliance Officer
110 South Centennial Dr., Ste. A,
Milliken, CO 80543
(970)617-4025
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Email
*
Your email
Date/Fecha
*
MM
/
DD
/
YYYY
Name of complainant/Nombre de querellante:
*
Your answer
School/Escuela:
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Your answer
Address/Direccion:
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Your answer
Phone number/Numero de teléfono:
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Your answer
Please select the reason for the appeal.
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Improper procedure followed
New evidence available
Bias or conflict by a previous Title IX team member
Required
Please provide grounds for your selection below:
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Your answer
Signature of Complainant
*
Your answer
A copy of your responses will be emailed to the address you provided.
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