New Submission

Section 1.4.F.1 - Sexual Harassment Complaint Form
DYSART Unified School District ("the District") complies with federal and state laws prohibiting unlawful discrimination based on race, color, national origin, sex, disability and age in its programs and activities. Any person that believes they have been harassed or discriminated against based on his/her sex can file a complaint under this procedure by contacting the District's Title IX Coordinators as follows:
Mr. Steve Mattingly
Director of Human Relations
Title IX Coordinator
15802 North Parkview Place
Surprise, Arizona 85374
(623) 876-7876
Steven.Mattingly@dysart.org
Date
Date captured on form submission
Please enter your full name, address and phone # and email below.
Complainant Name*
Address*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Home Phone #*
Work Phone #
Respondent Name*
person whom complaint is against
1. Describe the alleged sexual harrasment in specific terms.
Include:
a. The specific incident or activity that is alleged to be in violation of Title IX
b. The name of all individuals involved.
c. Dates, times, and locationd involved.
*
2. Describe any relevant communication that has already occurred to address this issue. Please specify the types of communication, dates, and names of individuals with whom any communication has occurred.
*
3. Do you want this Complaint to be formally investigated and addressed by the School?
*
YesNo
If 'No', please clarify:
I do not want a formal investigation. I am just bringing this to the School's attention.I do not want a formal investigation. I would like to speak with the Title IX Coordinator.other
Signature of Complainant*
Date Signed:
Date captured on form submission
Reference: Section 1.4, Form 1.4.F.1