INDEPENDENT SCHOOL DISTRICT NO. 81
 
INDEPENDENT SCHOOL DISTRICT NO. 81
UNLAWFUL SEX DISCRIMINATION TOWARD A STUDENT

General Statement of Policy Prohibiting Unlawful Sex Discrimination Toward a Student
Independent School District No. 81 maintains a firm policy prohibiting all forms of unlawful sex discrimination. All students are to be treated with respect and dignity. Unlawful sex discrimination by any teacher, administrator or other school personnel will not be tolerated under any circumstances. Complainant:,___________________________________________________
Home Address:, _________________________________________________
Work Address:, _________________________________________________
Home Phone: ______________________________________Work Phone: ________________________
Date of Alleged Incident(s): _______________________________________ Name of person you believe unlawfully discriminated toward you or a student on the basis of sex: _______________
If the alleged unlawful sex discrimination was toward another person, identify that person: _____________________
Describe the incident(s) as clearly as possible, including such things as: what force, if any, was used; any verbal statements (i.e. threats, requests, demands, etc.); what, if any, physical contact was involved; etc. (Attach additional pages if necessary): ________________________________________________________________________
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Where and when did the incident(s) occur: _______________________________________________________
List any witnesses that were present:,____________________________________________________________
This complaint is filed based on my honest belief that ______________________________________has unlawfully discriminated against me or a student on the basis of sex. I hereby certify that the information I have provided in this complaint is true, correct and complete to the best of my knowledge and belief.
___________________________________________________ ___________________________
(Complainant Signature) (Date)


Received by: ________________________________________ Date________________________