Ivy Preparatory Academy's Title IX Complaint Online Form

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PURPOSE: The purpose of the Title IX formal complaint process is to inform the District of allegations of sexual harassment, sexual violence, and sex discrimination in violation of Title IX of the Education Amendments of 1972 (“Title IX”) so that the District may take appropriate action.

INSTRUCTIONS: Individuals alleging Title IX sexual harassment and requesting a review are required to complete this form and submit it to the designated Title IX Coordinator as soon as possible after the occurrence of the alleged harassment.

Name of Complainant (person making report) *

Name of Respondent (person alleged of the harassment) *

Nature of Complaint *

When and where did the actions describe above occur? *

Are there any witnesses to this matter? *

Yes

If yes, please identify the witness (es)

Did you discuss this matter with any of the witnesses identified above? *

Yes

Date of discussion with other witness(es)

YYYY

Method of communication with witness(es)

Have you spoken to any administrator(s) or other District staff member(s), about this matter? *

Yes

If yes, please identify person(s) to who you have spoken

Date of communication with administrator(s) or staff member(s)

YYYY

Method of communication with administrator(s) or staff member(s)

Please describe any pieces of information that are relevant to your complaint

Name *

Date Submitted *

YYYY

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