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
Your answer
Address, City, Zip
Your answer
Phone
Your answer
Complainant: You are filing this on behalf of:
School name
Your answer
Principal's name
Your answer
School address and city
Your answer
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)
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:
Your answer
List the individuals involved in the incident(s) complaint of:
Your answer
List any witnesses to the incident(s):
Your answer
Describe the location where the incident(s) occurred:
Your answer
Please list all the date(s) and times when the incident(s) occurred or when the alleged acts first came to your attention:
Your answer
What steps, if any, have you taken to resolve this issue before filing a complaint?
Your answer
Submit
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