Discrimination and Harassment Complaint Form

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This form is designed for Complaints of Student Discrimination and/or Harassment in accordance with ACAA and ACAA-R policies which can be found below.

Students:
ACAA: https://www.carrabec.org/board-district-information/policies/policy---acaa

ACAA-R: https://www.carrabec.org/board-district-information/policies/policy---acaa-r

Staff:

ACAB: https://www.carrabec.org/board-district-information/policies/policy---acab

ACAB-R: https://www.carrabec.org/board-district-information/policies/acab-r

RSU #74 is committed to fostering respect, compassion, integrity, responsibility, and cooperation for all students and prohibits discrimination and harassment of students. If you are aware of any student discrimination or harassment, please submit a complaint using the following form. If you have any questions, please contact the Title IX Coordinator, Tammy Wyman (twyman@carrabec.org) or your building administrator.

Please complete the form's required fields on the first page; additional fields on page two are optional.

You may remain anonymous should you choose. If you would like to be contacted, please provide your information in the second section.

I wish to file a complaint *

Yes

Required

Complainant (Person Filing Complaint) *

Student

School Employee

Parent

Other:

Type of Discrimination or Harassment
*

Race

Religion

Sexual Orientation

Color

Sex

Citizenship

Disability

Age

Origin

Gender identity

Ancestry or National Origin

Other:

Date of Incident

Approximate date, time, and location information

Name(s) of person(s) alleged to have engaged in discrimination or harassment

Enter the name(s) of those committing the incident.

Name(s) of person(s) alleged to have been discriminated against or harassed

Enter the name(s) of the victim(s)

Description of Incident

Please explain in as much detail as possible the discrimination and/or harassment that you believe has occurred.

Witnesses

Please list the names and contact information of any other individuals who may have witnessed or have information about the alleged discrimination or harassment.

Confirmation
*

I hereby attest to the truth and accuracy of the information reported in this form.

Required

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