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FREIRE SCHOOLS HARASSMENT COMPLAINT FORM
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Please Select the Type of Complaint You are Making:
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Title IX Sexual Harassment
Title IX Retaliation
Harassment
Bullying
Hazing
Which Freire school/entity are you affiliated with?
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TECH Freire High School
Freire Wilmington
Freire High School
Freire Middle School
Freire Schools Collaborative
I am filing this complaint as (Choose One)
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Student
Employee
Parent/Guardian
Third-Party (e.g. Title IX Coordinator)
Complainant(s): Please provide the name of the person(s) who is alleged to be the victim of conduct that could constitute sexual harassment, retaliation, harassment, bullying, or hazing.
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Your answer
Name of Parent/Guardian, if complainant is a minor:
Your answer
Student ID/Employee ID (if applicable):
Your answer
Grade (if applicable)
Choose
5
6
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9
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12
Email Address of the person filing the compliant:
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Your answer
Home Address of the person filing the complaint:
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Your answer
Telephone Number of the person filing the complaint:
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Your answer
If you have already spoken to an administrator/teacher about this complaint, what is the name of the administrator/teacher you made the report to?
Your answer
If you have already spoken to an administrator/teacher about this complaint, what was the date you made the initial report?
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DD
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YYYY
Location of the alleged incident(s):
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Your answer
Please provide the name of the person(s) who you believe committed the offense, i.e. Respondent(s), and their relationship to the Complainant (e.g. classmate, colleague, staff member, etc.)
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Your answer
Complaint: Describe your complaint. Please provide as much information as possible.
If you are alleging retaliation, please describe the protected activity (e.g. filing a complaint of sexual harassment, opposing sexual harassment, serving as a witness to a sexual harassment complaint, etc.) forming the basis for this retaliation Complaint:
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Your answer
Witnesses: Please list the names of any witnesses along with any relationship you share with this witness (e.g. co-worker, classmate, teacher, non, etc.)
Your answer
Does evidence exist? If so, what type (e.g. text messages, photos, videos, etc.)? Please keep and preserve these materials.
Your answer
List any supportive measures being requested.
Your answer
Is there anything else you would like us to know?
Your answer
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