1310.2 Alleged Discrimination Form


RESOLUTION OF DISCRIMINATION COMPLAINTS

1310.2 ALLEGED DISCRIMINATION or MISTREATMENT

COMPLAINT REPORT FORM

 

Name:
[ ] Student
[ ] Employee

Building:

Type of discrimination alleged:
[ ] Title IX (sex)
[ ] Title VI (race, color, national origin)
[ ] Section 504 (disability)
[ ] Age
[ ] Race
[ ] Color
[ ] National Origin
[ ] Sexual Orientation
[ ] Ethnicity
[ ] Marital Status
[ ] Bullying
[ ] Other (Specify)


Specific facts of complaint (Who? What? Where? When?)

 

Specific relief desired (What do you want to be done or corrected?)

 

(Date)


(Signature of Student, Parent, Guardian, or District Personnel)

 

 

11-14-2011