Discrimination & Harassment Complaint Form

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Wis. Stat. 118.13 Pupil Discrimination Prohibited

(1) Except as provided in s. 123/13(37m), no person may be denied admission to any public school or be denied participation in, be denied the benefit of, or be discriminate against in any curricular, extracurricular, pupil services, recreational, or other program or activity because of a person’s sex, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional, or learning disability.

The Director of Pupil Services or Designee investigates complaints by parent, staff and students who believe themselves to be harmed because because of a person’s sex, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional, or learning disability. Please complete the form to the best of your ability.

Email *

Record my email address with my response

Person completing this report: *

Email of person completing this report: *

I am filling out this complaint as a: *

Complainant (Name of person experiencing harm): *

Complainant Email:

Complainant phone number:

Complainant address: *

If complainant is a student, list grade and school:

Type of Incident: *

Protected Class: *

Respondent (Name of person doing harm): *

Role of respondent (person doing harm): *

Incident date *

Incident time:

Time

Incident Location: *

Description of incident: *

Witness of incident & contact information:

I certify that the aforementioned information is true and correct (type your name): *

Send me a copy of my responses.

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