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