Speak Up!
The content of this form is confidential and will be read only by school and district administrators. In addition to using this form, we encourage you to speak to a trusted adult or colleague on your campus (teacher, counselor, administrator, club advisor, instructional aide) or the District Title IX Coordinator about your feelings and concerns regarding this situation.

Piedmont is committed to maintaining a safe environment that is free from harassment and discrimination. We prohibit unlawful discrimination, harassment (including sexual harassment), intimidation, and bullying of any student based on their actual or perceived race, color, ancestry, national origin, ethnic group identification, age, religion, marital or parental status, physical or mental ability, sex, sexual orientation, gender, gender identity, or gender expression; or on the basis of a person’s association with a person or group with one or more of these actual or perceived characteristics.

To read more about our bullying/harassment policy, go to: http://www.piedmont.k12.ca.us/district-info/non-discrimination-policy/ and to our Board Policy /Administrative Regulation http://www.piedmont.k12.ca.us/forms/board/BP-AR-5145.3-Discr-et-al.pdf.

To talk with the District Title IX Coordinator, Dr. Cheryl Wozniak, call 510-594-2686 or send an email to cwozniak@piedmont.k12.ca.us.

Name (optional but recommended)
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Reporting person status
What is the full name of the person being harassed or treated unkindly/unfairly?
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Grade level of the victim
When did the behavior(s) occur?
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