AC-E-2 Nondiscrimination Equal Opportunity - Complaint Form

Policy AC-E-2

Adopted:  1st Reading: 10/26/2015, 2nd Reading: 11/30/2015

                                                                                                                                                                                 

              

Nondiscrimination/Equal Opportunity

(Complaint Form)

 

Date:_______________________

 

Name of complainant:__________________________________________________________________

 

School:_______________________________________________________________________________

 

Address:______________________________________________________________________________

 

Phone:______________________________________

 

Summary of alleged unlawful discrimination or harassment:

 

 

 

 

 

 

 

Name(s) of individual(s) allegedly engaging in prohibited conduct:

 

 

 

Date(s) alleged prohibited conduct occurred:

 

 

Name(s) of witness(es) to alleged prohibited conduct:

 

 

If others are affected by the possible unlawful discrimination or harassment, please give their names:

 

 

Your suggestions regarding resolving the complaint:__________________________________________

 

 

 

Policy AC-E-2

Adopted: 1st reading 10/26/15

 

Please describe any corrective action you wish to see taken with regard to the alleged unlawful discrimination or harassment.  You may also provide other information relevant to this complaint.

 

 

 

 

 

 

 

 

 

 

__________________________________________________                           __________________________

Signature of complainant                                                                                            Date

 

 

__________________________________________________                           __________________________

Signature of person receiving complaint                                                              Date

 

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