Report Sexual Harassment

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If you or someone you know has been a victim of sexual harassment, please use this form to notify the District's Title IX Coordinator. You will receive a response within three (3) school days. If you do not receive a response after three (3) school days, please email TitleIX@SanJuan.Edu

Email *

Phone Number

Name *

Are you the Complainant (victim) in this incident? *

Yes

What is the Complainant's name? (If different than above)

If you are not the Complainant in this incident, what is your relationship to the Complainant?

Parent/Guardian

Witness

Other

Clear selection

Which scenario best illustrates this incident?

Complainant (Student) vs. Respondent (Student)

Complainant (Student) vs. Respondent (Staff)

Complainant (Staff) vs. Respondent (Student)

Complainant (Staff) vs. Respondent (Staff)

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What school is the Complainant enrolled or employed? *

What school is the Respondent enrolled or employed? *

Please enter the date of the incident? *

YYYY

Did the incident occur during a district related activity? *

Yes

Were there any Witnesses to the incident? If so, please list them here. *

Please provide the name of the Respondent(s).

Please provide a description of the incident, including as much detail as possible. *

If a school administrator has been notified about this incident, please provide their name. *

If the Human Resources Department hasbeen notified about this incident, please provide their name. *

If your Union Representative has been notified about this incident, please provide their name. *

If law enforcement has been notified about this incident, please include the case number and contact number for the officer involved. *

By completing this form, you are formally requesting that legal services start an investigation, if this matter is determined to be a Title IX violation. *

Yes

Send me a copy of my responses.

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