Title IX Complaint Form
PURPOSE: The purpose of the Title IX grievance procedures is to secure, at the lowest level, prompt and equitable resolutions of complaints based on sex discrimination, including complaints of sexual harassment or sexual violence, in violation of Title IX of the Education Amendments of 1972 (“Title IX”) and violation of District policies that prohibit these types of discrimination. These procedures apply only to complaints alleging discrimination prohibited by Title IX (including sexual harassment and sexual violence).
INSTRUCTIONS: Individuals alleging Title IX discrimination and requesting review are required to complete this form as soon as possible after occurrence of the alleged discrimination.
Title IX Complaints (students and staff):
Tyrone Weeks -
tyrone.weeks@fpsk12.net
* Required
Name of Complainant:
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Your answer
Home Address
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Your answer
School/Office
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Your answer
Nature of Grievance:
Please describe the action you believe may be sex discrimination,including complaints of sexual harassment or sexual violence, in violation of Title IX and identify with reasonable particularity any person(s) you believe may be responsible.
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Your answer
When did the actions described above occur?
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Your answer
Are there any witnesses to this matter?
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Yes
No
If the above answer to the question is yes, please identify the witnesses.
Your answer
Did you discuss this matter with any of the witnesses identified in the previous question?
Yes
No
Clear selection
If you answered yes to the question above, please identify the Person(s) to whom you have spoken and the method of communication
Your answer
Have you spoken to any administrator(s) or other District employee(s) about this matter?
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Yes
No
If you answered yes to the question above, please identify the Person(s) to whom you have spoken and the method of communication
Your answer
Please describe the result of the discussion(s) identified in the question above
Your answer
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