Title IX Complaint Form

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PURPOSE: The purpose of the Title IX grievance procedures is to secure, at the lowest level, prompt and equitable resolutions of complaints based on sex discrimination, including complaints of sexual harassment or sexual violence, in violation of Title IX of the Education Amendments of 1972 (“Title IX”) and violation of District policies that prohibit these types of discrimination. These procedures apply only to complaints alleging discrimination prohibited by Title IX (including sexual harassment and sexual violence).

INSTRUCTIONS: Individuals alleging Title IX discrimination and requesting review are required to complete this form as soon as possible after occurrence of the alleged discrimination.

Title IX Complaints (students and staff):
Christopher O'Brien - christopher.obrien@fpsk12.net

Name of Complainant: *

Home Address *

School/Office *

Nature of Grievance:

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. *

When did the actions described above occur? *

Are there any witnesses to this matter? *

Yes

If the above answer to the question is yes, please identify the witnesses.

Did you discuss this matter with any of the witnesses identified in the previous question?

Yes

Clear selection

If you answered yes to the question above, please identify the Person(s) to whom you have spoken and the method of communication

Have you spoken to any administrator(s) or other District employee(s) about this matter? *

Yes

If you answered yes to the question above, please identify the Person(s) to whom you have spoken and the method of communication

Please describe the result of the discussion(s) identified in the question above

Submit

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