Complaint Form: Virginia DOE Office of School Nutrition Programs
To file a complaint related to an incident in the Eastern Mennonite School dining hall, please complete this online form within 180 days of the alleged discriminatory action to Andrea Wenger, Eastern Mennonite School Title IX Compliance Coordinator. You can also submit a complaint verbally to Andrea Wenger by phoning 540-236-6026, or emailing wengera@easternmennonite.org. The complaint will be processed within 90 days of receipt and forwarded to the Virginia Department of Education Office of School Nutrition Programs,  PO BOX 2120, Richmond, VA 23218-2120.
Sign in to Google to save your progress. Learn more
Name *
School *
Address *
Phone *
Email *
What happened to you? Please include date, location and any supporting documentation that would help show what happened. *
Who do you believe discriminated against you? List name(s). *
Name(s) of witness(es) alleged prohibited conduct if applicable: *
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.  I believe I was discriminated against based on: *
How would you like to see this compliant resolved? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eastern Mennonite School. Report Abuse
Google Forms