District 211 Title IX Sexual Harassment Formal Complaint Form

Administration Center Safety Concern Form

District 211 Title IX Sexual Harassment Formal Complaint Form

Date

First Name

Complainant (your) information

Last Name

Complainant (your) information

Phone Number

Email Address

What is your role with Township High School District 211?

Student

Faculty

Staff

Other

If other, explain:

Respondent(s) Name(s):

Respondent (alleged harasser) Information

Respondent(s) Relationship(s) to Complainant:

Respondent (alleged harasser) Information

Is/are the Respondent(s) enrolled or employed by Township High School District 211 and, if so, what is/are the Respondent(s) role(s) with the Township High School District 211 (check all that apply)?

If other, explain:

Where did the alleged sexual misconduct occur?

Note: Conduct must occur in the United States and within Township High School District 211's “education program or activity,” meaning locations, events, or circumstances over which the school exercises substantial control, including any building owned or controlled by a student organization that is officially recognized by the Township High School District 211, in order to be within the scope of Township High School District 211 Policy GAD/JB/KAB, Title IX Sexual Grievance Policy. Conduct occurring elsewhere may be able to be filed under other anti-discrimination and harassment policies and procedures of the Township High School District 211.

Check the box(es) below that best describe(s) the alleged incident.

Sexual harassment that is severe, pervasive, and objectively offensive that it effectively denied you equal access to the school's education program or activity (hostile environment sexual harassment)

Stalking

Sexual Assault

Domestic Violence

Dating Violence

An employee of Township High School District 211 conditioned an aid, service, or benefit on your participation in unwelcome sexual conduct (quid pro quo sexual harassment)

Not enrolled or employed by Township High School District 211

Other

(Note: may include online misconduct)

If other, explain:

Note: Township High School District 211 may dismiss a formal complaint or allegation if, at any time during the investigation or hearing, the Respondent is no longer enrolled or employed by Township High School District 211. If you need assistance with identifying which box(es) best describe your incident, contact the Township High School District 211 Title IX Coordinator.

Date(s) of Incident(s) (or time frame during which behavior persisted)

Describe the alleged incident(s) with as much detail as possible including the place it occurred, date, time, and individuals involved:

Confidentiality

Township High School District 211 will keep confidential the identity of any individual who has made a report or complaint of Title IX Sexual Harassment, including any individual who has made a report or filed a Formal Complaint of Title IX Sexual Harassment, any Title IX Complainant, any individual who has been reported to be the perpetrator of sex discrimination, any Respondent, and any witness, except as may be permitted by State law or the FERPA statute, 20 U.S.C. 1232g, or FERPA regulations, 34 CFR part 99, or as required by law, or to carry out the purposes of 34 CFR part 106, including the conduct of any investigation, hearing, or judicial proceeding arising thereunder. Title IX requires the District to notify all parties of the names of all other known parties if a Formal Complaint is filed by a Complainant or signed by the Title IX Coordinator or designee.

Retaliation

Neither Township High School District 211 nor any other person may intimidate, threaten, coerce, or discriminate against any individual for the purpose of interfering with any right or privilege secured by Title IX or Township High School District 211’s Title IX policies or procedures, or because the individual has made a report or Complaint, testified, assisted, or participated or refused to participate in any manner in an investigation, proceeding, or hearing under this part. Intimidation, threats, coercion, or discrimination, including charges against an individual for code of conduct violations that do not involve sex discrimination or Sexual Harassment, but arise out of the same facts or circumstances as a report or complaint of sex discrimination, or a report or Formal Complaint of Sexual Harassment, for the purpose of interfering with any right or privilege secured by Title IX or Township High School District 211’s Title IX policies or procedures, constitutes retaliation. Complaints alleging retaliation may be filed according to Township High School District 211 Policy GAC/JA/KAA, Uniform Grievance Policy.

Informal Resolution Option

Township High School District 211 offers a Title IX Informal Resolution process to resolve allegations of Title IX Sexual Harassment other than those involving an allegation of harassment of a student by an employee. This process does not include a full investigation and hearing, but instead involves facilitation or mediation between the parties. You will be contacted about the option to participate in Informal Resolution if you wish to do so.

By signing this document, I assert that the information listed above is true to the best of my knowledge and that I am requesting Township High School District 211 to investigate the Formal Complaint of Title IX Sexual Harassment.

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