102 E6 DISPOSITION OF COMPLAINT FORM

Code No. 102.E6

 

DISPOSITION OF COMPLAINT FORM

 

 

Date

 

 

 

Date of Initial Complaint

 

 

Name of Complainant (include whether the Complainant is a student or employee): :

 

 

Date and Place of Alleged Incident(s)

 

 

Name of Respondent (include whether the respondent is a student or employee)

 

 

 

 

 

 

_____________________________________________________

 

 

Nature of discrimination, harassment, or bullying alleged (check all that apply):

 

Age

 

Physical Attribute

 

Sex

 

Disability

 

Physical/Mental Ability

 

Sexual Orientation

 

Familial Status

 

Political Belief

 

Socio-economic Background

 

Gender Identity

 

Political Party Preference

 

Other – Please Specify:

 

Marital Status

 

Race/Color

 

 

 

National Origin/Ethnic Background/Ancestry

 

Religion/Creed

 

 

 

 

Summary of Investigation: __________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

Signature: _____________________________________      Date:  __________________________

 

MORNING SUN COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTOR