“Education is about children and as long as our efforts are aligned toward children we are on the right path.”
Deborah L. Hendrix President, Board of Education
District Exhibit AC-E2
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District Policy Index
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DISTRICT EXHIBIT AC-E2 Nondiscrimination/Equal Opportunity (Complaint Form) Date of revision: February 21, 2008 |
Nondiscrimination/Equal Opportunity (Complaint Form)
Date: ___________________________________________________
Name of complainant: ______________________________________
School: _________________________________________________
Address: ________________________________________________
Phone: __________________________________________________
Summary of alleged discrimination:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Name(s) of individual(s) committing alleged discrimination:
________________________________________________________________________
________________________________________________________________________
Date(s) of alleged discrimination occurred:
________________________________________________________________________
Name(s) of witness(es) to alleged discrimination:
________________________________________________________________________
________________________________________________________________________
If others are affected by the possible discrimination, please give their names:
________________________________________________________________________
________________________________________________________________________
Your suggestions regarding resolving the complaint:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please describe any corrective action you wish to see taken with regard to the alleged discrimination.
You may also provide other information relevant to this complaint.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
___________________________________________________ ____________________
Signature of complainant Date
___________________________________________________ ____________________
Signature of person receiving complaint Date