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FORMAL TITLE IX COMPLAINT

Title IX and Weber School District prohibit sexual harassment at school or at school-related activities or events.  All allegations of sexual harassment are taken seriously and will be reviewed by the District’s Title IX Coordinator.  If you believe you have been subjected to sexual harassment in violation of Title IX and Weber School District Policy 4120 please complete this form and it will be submitted to Heather Hardy, Title IX Coordinator at hhardy@wsd.net, Weber School District, 5320 Adams Ave. Pkwy, Ogden, UT 84405. For questions please call 801-476-7850.


Email *
Complainant Name: *
Complainant Grade/Level/Employment Position: *
Complainant School/Department: *
I AM REQUESTING AN INVESTIGATION INTO THE INCIDENT DESCRIBED BELOW. *
Respondent'(s) Name(s*):
*Please list all names if more than one
 *
Respondent'(s) School/Department: *
Date(s)/Time(s) of incident(s): *
Location of Incident: *
Names of Witnesses*:
*List anyone who may have informaiton helpful to the investigation
 *
Is this a repeat offense (to your knowledge): *
Describe the incident(s) as clearly as possible, including what was said (threats, requests, demands, etc.), whether any physical contact occurred, and what force was used:

 *
Describe the harm caused by the incident(s) described above, including any hostile school environment, or other adverse effects on your education:
 *
I am currently or seeking to be a student or an employee at Weber School District. *
I hereby represent that the information provided herein is true, correct, and complete to the best of my knowledge. 
*type your name and date in the anwer box *
A copy of your responses will be emailed to the address you provided.
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