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Sexual Harassment/Assault (Title IX) Complaint Form
Any stakeholder who would like to report a behavior that may violate Title IX protections may use this digital form as the official report. They may be required to sign a copy of the form during the investigation.
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Email
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Your email
Please describe the action you believe may be sex discrimination, including complaints of sexual harassment or sexual violence, in violation of Title IX and identify with reasonable particularity any person(s) you believe may be responsible.
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Your answer
When did the actions described above occur?
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Your answer
If there were witnesses, please list them.
Your answer
If you have spoken with anyone about the incident, please list who and what you have shared, as well as the date.
Your answer
Please describe the result of the discussions you have had about the incident.
Your answer
What is your name?
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Your answer
What is your role in the district?
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Choose
Student
Staff
Parent/Guardian
Other
What is your home address?
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Your answer
What school do you attend? (if applicable)
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Holt Junior High
Holt High School
Washington Woods
Hope
Elliott
Sycamore
Horizon
Dimondale
Wilcox
Midway
What grade are you in? (if applicable)
Your answer
By typing your name below, you certify that the information you shared is true and correct.
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A copy of your responses will be emailed to the address you provided.
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