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Title IX Incident Report Form
Greenway Public Schools ISD 316 maintains a firm policy prohibiting all forms of unlawful sex discrimination. All students and staff are to be treated with respect and dignity. Unlawful sex discrimination by any teacher, administrator, or other school personnel will not be tolerated under any circumstances.
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Email
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Your email
Complainant Name
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The individual reporting the incident's name.
Your answer
Address
Your answer
Phone Number
Your answer
Date of Alleged Incident(s)?
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DD
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Name of person you believe unlawfully discriminated toward you or a student on the basis of sex?
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Your answer
If the alleged unlawful sex discrimination was toward another person, identify that person
Your answer
Describe the incident(s) as clearly as possible, including such things as: what force, if any, was used; any verbal statements (i.e. threats, requests, demands, etc.); what, if any physical contact was involved; etc.
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Your answer
Where and when did the incident(s) occur?
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Your answer
List any witnesses that were present
Your answer
This complaint is filed based on my honest belief that _________ has unlawfully discriminated against me or a student on the basis of sex. I hereby certify that the information I have provided in this complaint is true, correct and complete to the best of my knowledge and belief. (Please type your name to electronically sign)
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Your answer
Date you are completing this form
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