Title IX Sexual Harassment Complaint Form  
Non-Discrimination Statement - It is the policy of the Crenshaw County Board of Education that no person shall be denied  employment, be excluded from participation in, be denied the benefits of, or be subjected to discrimination in any program or  activity on the basis of disability, sex, race, religion, national origin, color, or age. Ref: Sec.1983, Civil Rights Act, 42 U.S.C.: Title  VI and VII, Civil Rights Act of 1964; Rehabilitation Act of 1973, Sec. 504, Age Discrimination in Employment Act; Equal Pay Act of  1963; and the Title IX of the Education Amendment of 1972.
 
In accordance with Title IX (20 U.S.C. §1681, et seq.) the Crenshaw County Board of Education strictly prohibits discrimination on the  basis of sex or gender in its programs or activities, including sexual harassment, as defined by law and Board policy. Sexual  harassment complaints filed under Title IX regulations will require a completed Complaint Form and review from the Title IX  Coordinator.  

Crenshaw County Schools Title IX Coordinator Information  
Kris Odom
183 Votec Drive
Luverne, Alabama 36049
(334) 335-6519
(3340 335-6510 Fax  
kodom@crenshaw-schools.org

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Students:  
If you are a student who believes you have been a victim of sexual harassment, including sexual assault, sexual violence, or other sexual misconduct while on school grounds, school bus, school activity or online, you may report such conduct or file a complaint  under Title IX with the Title IX Coordinator of Crenshaw County Schools. Sexual Harassment is defined under Title IX guidelines as, “unwelcome conduct on the basis of sex that is so severe, pervasive, and objectively offensive that it effectively denies a person equal access to the school’s education program or activity”.  

I am filing this complaint as a: Student The Parent/Legal Guardian of:  
Student Name: *
School: *
Home Address: *
Parent/Legal Guardian Name: *
Parent/Legal Guardian Contact Number: *
Type of Complaint: *
Describe your complaint. Please summarize below and use additional pages if necessary. *
Name of person or persons you believe committed the offense against you.   *
Where did the incident occur? *
When did the incident occur? *
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Approximate time the incident occur? *
Time
:
How do you know the person or persons? *
Do you have classes together with the person or persons? *
If so, which classes:
Do you participate in extracurricular activities with the person or persons: *
If so, which activities:
Have you brought this matter to the attention of anyone else at the school or law enforcement? If so, please list the name(s)  of the people and their positions with whom you have discussed the matter. *
Example: John Smith - 10th Grade Math Teacher
Please list name(s) of any witnesses: *
Describe the corrective action you are seeking: *
Confirmation
I hereby acknowledge that by printing my name in the Signature section provide below that all information is accurate to the best of my knowledge
Signature: *
Please type your name.
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