Title IX Formal Complaint

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 Title IX Coordinator as soon as possible after the occurrence of the alleged harassment. 

Email *
Name of Complaint (person making report): *
Name of Respondent (person alleged of the harassment): *
Nature of Complaint *
When and where did the actions described above occur?  *
Are there any witnesses to this matter? *
Required
If yes, please identify person(s) to whom you have spoken:
Date of discussion with other witness(es):
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Method of communication with witness(es):
Have you spoken to any administrator(s) or other District staff member(s) about this matter?  *
Required
If yes, please identify person(s) to whom you have spoken:
Date of communication with administrator(s) or staff member(s):
MM
/
DD
/
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 *
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This form was created inside of Kildare Public School.