Discrimination Reporting Form (Title VI/VII) Complaint Form - Anti-discrimination)
Holt Public Schools is committed to a welcoming, safe environment. We are committed to protecting the rights of all of our stakeholders, including those outlined in Title VI and VII as anti-discrimination measures. Any stakeholder who would like to report a behavior that may violate Title VI/VII protections may use this digital form as the official report. They may be required to sign a copy of the form during the investigation.
登入 Google 即可儲存進度。瞭解詳情
電子郵件 *
Please describe the nature of the complaint.  *
When did the actions described above occur?   *
If there were witnesses, please list them.
If you have spoken with anyone about the incident, please list who and what you have shared, as well as the date.
Please describe the result of the discussions you have had about the incident.
What is your name? *
What is your role in the district? *
What is your home address? *
What is your phone number? *
What school do you attend? (if applicable)
What grade are you in? (if applicable)
By typing your name below, you certify that the information you shared is true and correct. *
系統會透過電子郵件將你的作答內容複本傳送到你所提供的地址。
提交
清除表單
請勿利用 Google 表單送出密碼。
reCAPTCHA
隱私權條款
這份表單是在 Holt Public Schools 中建立。 檢舉濫用情形
Google 表單