Our goal is to ensure that all employees and students are provided with a safe environment and receive all programs and services to which they are entitled. Thank you for bringing your complaint to our attention so that we can properly investigate the complaint and work towards equitable resolutions.
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What is the basis of your complaint? Please check all that apply.
Bullying or Harassment
Title I (Improving the Academic Achievement of the Disadvantaged)
Title VI (Prohibits discrimination on the basis of race, color, or national origin in any program or activity that receives Federal funds or other Federal financial assistance.
Title VII (Indian, Native Hawaiian and Alaska Native Education)
Title IX (Protects people from discrimination based on sex in education programs or activities that receive Federal financial assistance.
Racial/ethnic or religious discrimination
Physical or verbal assault
Americans with Disabilities Act (ADA)
Family Medical Leave (FMLA)
Rehabilitation Act - Section 504 (Prohibits discrimination based upon disability.)
Please provide your name and contact information so that we may properly address the complaint.
When did the events that led to your complaint occur?
Where did the conduct occur?
Are you filling out this form for yourself or for someone else? (please identify the person if you are submitting on behalf of someone else.)
Who or what entity do you believe is responsible for the conduct?
Please provide the names of any witnesses to the conduct.
Have you discussed this matter with any of the witnesses? If so, who?
Please describe what happened in detail; be as specific as possible.
Have you discussed this matter with anyone else? If so, who?
What would you like to see happen as a resolution to your complaint?
I agree that all of the information on this form is accurate and true to the best of my knowledge and belief. (Please check both boxes.)
By checking this box I agree that this is my electronic signature.
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This form was created inside of Bettendorf Community School District.