MVWSD Discrimination/Harassment Complaint Reporting Form
Use this form to submit a Discrimination/Harassment complaint to MVWSD.
In accordance with the District’s Uniform Complaint Procedures (5 CCR 4620) each school district shall follow uniform complaint procedures when addressing complaints alleging unlawful discrimination, harassment, intimidation and bullying against any protected group. Protected groups are enumerated by Education Code §§ 200 and 220, Additionally, it is the policy of the State of California, pursuant to Section 200, that all individuals shall enjoy freedom from discrimination and/or harassment of any kind in the educational institutions of the state. This also includes sexual harassment, which is a form of sexual discrimination (EC § 231.5).
Contact information: Your name
Address, City, Zip
Complainant: You are filing this on behalf of:
Your child or a student
School address and city
Basis of complaint: Please check the following box(s), based on the type(s) of discrimination, harassment, intimidation and bullying you experienced, (Education Code §§ 200 and 220)
Mental or physical disability
Association with any of these categories
Sex (Title IX)
Details of Complaint: Please answer the following questions to the best of your ability. Please describe the type of incident(s) you experienced that led to this complaint, including the events or actions, in as much detail as possible:
List the individuals involved in the incident(s) complaint of:
List any witnesses to the incident(s):
Describe the location where the incident(s) occurred:
Please list all the date(s) and times when the incident(s) occurred or when the alleged acts first came to your attention:
What steps, if any, have you taken to resolve this issue before filing a complaint?
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This form was created inside of Mountain View Whisman School District.