Valley View School District Title IX and Discrimination, Harassment and Retaliation Complaint Form
Complete this form to initiate a formal complaint investigation into an allegation of actual or perceived discrimination, harassment, including sexual harassment, and/or retaliation which is prohibited by Title IX of the Education Amendment of 1972 (“Title IX”), Title VII of the Civil Rights Act of 1964 (“Title VII”) or Title VI of the Civil Rights Act of 1964 (“Title VI”) and involves a Valley View School District (“District”) student or staff member.

A formal complaint of actual or perceived discrimination, harassment, including sexual harassment, or retaliation may be brought by students, parents/guardians, District staff or community members.  The formal complaint must be signed in order for the investigation to begin.  If you are submitting the form electronically, an electronic signature is acceptable.  Complaints should be filed within 90 days of the alleged incident.

NOTE:  All District teachers and staff are required to report allegations of sexual misconduct against a student, whether by another student or adult, that they have witnessed or heard about to the Title IX/Nondiscrimination Coordinator using this form.

Definitions of discrimination, harassment, including sexual harassment, and retaliation can be found in Board Policies 5.20 (General Personnel) and 7.20 (Students) and the District’s Title IX, Discrimination, Harassment, and Retaliation Grievance Guidelines for the 2020-2021 school year.

The District cannot guarantee that your complaint will remain confidential. In certain instances, the District may be required by law to disclose this complaint.

The completed form should be electronically submitted by hitting "Submit".  If preferred, the form may be printed and sent to the District’s Title IX/Nondiscrimination Coordinator via U.S. mail, fax or email at:
Dr. Judie Nash
801 W. Normantown Road,  Romeoville, IL  60446
Fax:  815-886-7820
Email:

If you have any questions, call the District’s Title IX/Nondiscrimination Coordinator at 815-886-2700.


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Name of person completing this form: *
Phone Number: *
Email Address: *
Name of person you believe was harmed. *
If a student, what school does s/he attend?
If a District staff person, where does s/he work?
Indicate where the alleged incident occurred: *
Required
Off campus grounds
Day alleged incident occurred: *
MM
/
DD
/
YYYY
Time alleged incident occurred: *
Required
Identify type of alleged incident which occurred: *
Required
If discrimination was the type of alleged incident, identify the protected category.
If harassment was the type of alleged incident, identify the protected category.
Describe the alleged incident. *
Does evidence exist? (e.g. texts, photos, video) If so, please keep these materials. *
Name of person(s) you believe caused the harm: *
If a student, what school does s/he attend?
If a District staff person, where does s/he work?
Please provide any other information you believe is relevant:
Electronic Signature (Type your name) *
Submit
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