Title IX Discrimination Complaint Form
Any person may report sex discrimination, including Sexual Harassment (whether or not the person reporting is the person alleged to be the victim of conduct that could constitute sex discrimination or Sexual Harassment), in person, by mail, by telephone, or by electronic mail, using the Title IX Coordinator’s(s’) contact information listed above, or by any other means that results in the Title IX Coordinator receiving the person’s oral or written report. Reports may be made at any time (including during non-business hours), by using the telephone number(s) or electronic mail address(es), or by mail to the office address(es), listed for the Title IX Coordinator(s).  In case of an emergency, please contact the police.   The Board Policy #2266 can be found online at: https://go.boarddocs.com/oh/akron/Board.nsf/goto?open&id=BSFHY74ABB17# 
Sign in to Google to save your progress. Learn more
Email *
Name *
Student or Staff ID Number *
Are you a Student or Staff Member? *
School Name or Work Location *
Your Address *
Your Phone Number *
Your Email Address *
Type of Complaint *
Required
Description of complaint.   *
When did the actions occur?   *
Where did the actions occur? *
Name of person or persons you believe committed the offense against you and how you have contact with them, e.g. another student, supervisor, co-worker, etc.   *
Describe the corrective action you are seeking. *
List any witnesses.   If there were no witnesses, please write none.   *
Are you requesting that the District investigate the allegations contained in this complaint? *
By checking agree, I certify the aforementioned is true and correct. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Akron Public Schools.

Does this form look suspicious? Report

Google Forms