Providence Hall Charter School Title IX Grievance Form
Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681) is an all-encompassing federal law that prohibits discrimination based on the gender of students and employees of educational institutions that receive federal financial assistance. 

This form is available for Providence Hall community members to submit any concerns related to Title IX, discrimination, and/or harassment.  

If you require emergency assistance, please call 801-727-8260 and ask for the Title IX Coordinator.

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I am filing this complaint as a: *
Your FIRST & LAST Name - If you wish to remain anonymous you may leave blank, but then we will not be able to contact you if needed.
Which campus does your grievance associated with?  *
Your Phone Number - This is optional, but if you want us to contact you then please include.
Have you brought your grievance to the attention of any Providence Hall employee?  *
If you answered YES above and you HAVE brought this matter to the attention of a Providence Hall employee, then list the name(s) of the employee(s) who you have discussed your grievance with.
Type of Grievance (check all that apply) *
Required
Summarize your grievance. *
Give the name of each individual person involved in the grievance. *
For each witness to your grievance, provide the following: 1) Their First & Last Name; 2) Their Relationship to You (co-worker, teacher, etc.); and 3) Their Phone Number (including area code) *
Statements & Agreements *
I have read, understand, and agree to this statement.
The Title IX Coordinator and/or designee investigate complaints by employees and students who believe themselves to be harmed by sexual harassment or discrimination and harassment related to gender.
Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681) is an all-encompassing federal law that prohibits discrimination based on the gender of students and employees of educational institutions which receive federal financial assistance.
If I require emergency assistance, I call 801-727-8260 and ask for the Title IX Coordinator.
I am signing this form electronically and my electronic signature is the legal equivalent of my manual signature on this form.
Type in First & Last Name of Person who completed this form as Signature:  If you selected in this form you were completing "Anonymous" then type that in here instead of your name. *
Today's DATE (mm/dd/yyyy) *
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