Title IX Complaint Form

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This form only applies to complaints alleging discrimination prohibited by Title IX (including sexual harassment and sexual violence).

Please contact the Title IX Coordinator if you have any questions at:

TitleIX-Nondiscrimination-Coordinator@adams12.org or (720) 972-4179.

Name of Complainant *

Contact Information (please include address, phone number, and email) *

School *

Grade Level/Position *

Summary of alleged prohibited conduct: Please detail the conduct you believe may be sex discrimination, including complaints of sexual harassment, in violation of Title IX. *

Date alleged prohibited conduct occurred *

YYYY

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

Are there any witnesses to the alleged prohibited conduct? *

Yes

If yes, please identify the witnesses

Resolution of Complaint: Please share how you would like to see this complaint resolved.

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