HPS Discrimination Complaint Form
The Hopkinton Public Schools do not discriminate and are committed to maintaining a school environment free of harassment on the basis of race, traits historically associated with race, color, religion, national origin, sex, age, sexual orientation, sex stereotypes and sex characteristics, gender identity, ancestry, athletic performance, homelessness, socioeconomic status, disability, pregnancy or pregnancy related condition, academic performance, or proficiency in the English language in admission to, access to, employment in, or treatment in its programs and activities. Harassment by administrators, certified and support personnel, students, vendors and other individuals at school or at school-sponsored events is unlawful and is strictly prohibited. The Hopkinton Public Schools require all employees and students to conduct themselves in an appropriate manner with respect to their fellow employees, students and all members of the school community.

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Please identify the alleged violation of which protection: *
PART 1: Complainant
Complainant Name *
Is Complainant a Student? *
If YES, what grade? *
Is Complainant an Employee? *
If YES, please indicate position and primary employment location: *
Home Address *
Email *
Phone *
PART 2: Respondent
Respondent Name *
Is Respondent a Student? *
If YES, what grade? *
Is Respondent an Employee? *
If YES, please indicate position and primary employment location: *
PART 3: Incident
Date & Time of Incident(s)
Location of Incident(s)

Description of Incident(s)

Describe with specificity the details of the alleged harassment (including names of the people involved, what occurred and what each person did and said, including specific words used).

PART 4: Witnesses
Name(s) and Roles(s) – Student, Staff, Parent, etc.
Name(s) and Roles(s) – Student, Staff, Parent, etc.
Did you discuss this matter with any of the witnesses listed above? *
If YES, please identify the witness(es) and the nature of the conversations.
PART 5: Additional Information & Certification
PLEASE LIST ANY OTHER SOURCES OF INFORMATION THAT YOU FEEL ARE RELEVANT TO YOUR COMPLAINT (SUCH AS CORRESPONDENCE, EMAILS, SCREENSHOTS OR OTHER DOCUMENTS). YOU CAN SEND ANY ADDITIONAL INFORMATION TO THE APPROPRIATE TITLE IX COORDINATOR LISTED ABOVE.
By typing my full name below, I certify that the information contained in this Title IX Complaint Form is true and correct to the best of my knowledge and I request that Hopkinton Public Schools investigate the allegations contained herein.
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