5145.5- Title IX Sex Discrimination and Harassment (Forms)
COMPLAINT FORM REGARDING SEXUAL HARASSMENT UNDER TITLE IX (STUDENTS)
This complaint form should be used for complaints of sexual harassment as defined on page 1 of the Board’s Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students)
Name of the complainant __________________________________________________________
Date of the complaint _____________________________________________________________
Date of the alleged sexual harassment _______________________________________________
Name or names of the sexual harasser(s) _____________________________________________
_______________________________________________________________________________
Location where such sexual harassment occurred _______________________________________
_______________________________________________________________________________
Name(s) of any witness(es) to the sexual harassment _______________________________________________________________________________
_______________________________________________________________________________
Detailed statement of the circumstances constituting the alleged sexual harassment
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Remedy requested________________________________________________________________
Signature of Complainant or Title IX Coordinator: _______________________________________
COMPLAINT FORM REGARDING SEX DISCRIMINATION (OTHER THAN SEXUAL HARASSMENT UNDER TITLE IX) (STUDENTS)
This complaint form should be used for complaints of sex discrimination as defined on page 1 of the Board’s Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students)
Name of the complainant __________________________________________________________
Date of the complaint _____________________________________________________________
Date of the alleged sex discrimination ________________________________________________
Name or names of the sex discriminator(s) ___________________________________________
_______________________________________________________________________________
Location where such sex discrimination occurred _______________________________________
_______________________________________________________________________________
Name(s) of any witness(es) to the sex discrimination ___________________________________
_____ ___________________
Detailed statement of the circumstances constituting the alleged sex discrimination
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Remedy requested________________________________________________________________
Signature: ______________________________
SAMPLE WRITTEN NOTICE FOR FORMAL COMPLAINTS OF STUDENT/STUDENT SEXUAL HARASSMENT
[LETTERHEAD]
NOTICE OF SEXUAL HARASSMENT ALLEGATIONS UNDER TITLE IX
AND NOTICE OF BULLYING INVESTIGATION UNDER CONN. GEN. STAT. § 10-222d
In accordance with the Board’s Policy and Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students), a formal complaint of sexual harassment has been filed with or signed by the Title IX Coordinator. The formal complaint shall also be considered a written report of suspected bullying under the Board’s Bullying Prevention and Intervention Policy and Connecticut General Statutes § 10-222d. As such, a bullying investigation pursuant to the foregoing policy and statute will be conducted as part of the Title IX grievance process. This notice shall serve as notification that an investigation of alleged Title IX sexual harassment and bullying has commenced. Please be advised that students are entitled to different and additional procedural rights under the Title IX grievance process than under the Board’s Bullying Prevention and Intervention Policy.
Identities of the parties involved, if known:
__________________________________________________________(Complainant(s))
__________________________________________________________ (Respondent(s))
The conduct allegedly constituting sexual harassment and bullying: ________________________________________________________________________________________________________________________________________________________________________________________________________________________
The date and the location of the alleged incident, if known: __________________________________________________________________
The Title IX Coordinator or designee will contact the parties regarding the next step in the grievance process. Questions can be directed to the Title IX Coordinator:
COORDINATOR: Gary Highsmith
OFFICE ADDRESS: 60 Putnam Avenue, Hamden, CT 06514
ELECTRONIC MAIL ADDRESS: ghighsmith@hamden.org
TELEPHONE NUMBER: 203.407.2059
Procedural Rights Under Title IX:
· The respondent is presumed not responsible for the alleged conduct. A determination regarding responsibility under Title IX is made at the conclusion of the grievance process.
· All parties involved in the Title IX grievance process may have an advisor of their choice who may be, but it not required to be, an attorney. This advisor may inspect and review evidence as permitted by the Board’s Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students).
It is a violation of the Board’s Student Discipline Policy to lie to school officials or otherwise engage in dishonest behavior, which includes knowingly making false statements or knowingly submitting false information during the grievance process. Any student who knowingly makes false statements or knowingly submits false information during this grievance process will be subject to sanctions pursuant to the Board’s Student Discipline Policy.
A copy of the Board’s Policy and Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students) and the Board’s Bullying Prevention and Intervention Policy is included with this notice.
SAMPLE WRITTEN NOTICE FOR FORMAL COMPLAINTS OF STUDENT/EMPLOYEE SEXUAL HARASSMENT
[LETTERHEAD]
NOTICE OF SEXUAL HARASSMENT ALLEGATIONS UNDER TITLE IX
In accordance with the Board’s Policy and Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students), a formal complaint of sexual harassment has been filed with or signed by the Title IX Coordinator.
Identities of the parties involved, if known:
__________________________________________________________(Complainant(s))
__________________________________________________________ (Respondent(s))
The conduct allegedly constituting sexual harassment: ________________________________________________________________________________________________________________________________________________________________________________________________________________________
The date and the location of the alleged incident, if known: __________________________________________________________________
The Title IX Coordinator or designee will contact the parties regarding the next step in the grievance process. Questions can be directed to the Title IX Coordinator:
COORDINATOR: Gary Highsmith
OFFICE ADDRESS: 60 Putnam Avenue, Hamden, CT 06514
ELECTRONIC MAIL ADDRESS: ghighsmith@hamden.org
TELEPHONE NUMBER: 203.407.2059
The respondent is presumed not responsible for the alleged conduct. A determination regarding responsibility is made at the conclusion of the grievance process.
All parties involved may have an advisor of their choice who may be, but it not required to be, an attorney. This advisor may inspect and review evidence as permitted by the Board’s Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students).
It is a violation of the Board’s Student Discipline Policy to lie to school officials or otherwise engage in dishonest behavior, which includes knowingly making false statements or knowingly submitting false information during the grievance process. Any student who knowingly makes false statements or knowingly submits false information during this grievance process will be subject to sanctions pursuant to the Board’s Student Discipline Policy. Any employee who knowingly makes false statements or knowing submits false information during this grievance process is subject to discipline, up to and including termination.
A copy of the Board’s Policy and Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students) is included with this notice.
SAMPLE WRITTEN NOTICE FOR THE INFORMAL RESOLUTION PROCESS FOR SEXUAL HARASSMENT COMPLAINTS
[LETTERHEAD]
NOTICE OF INFORMAL RESOLUTION PROCESS FOR SEXUAL HARASSMENT COMPLAINTS UNDER TITLE IX
In accordance with the Board’s Policy and Administrative Regulations Regarding Title IX of the Education Amendments of 1972 - Prohibition of Sex Discrimination and Sexual Harassment (Students), a formal complaint of sexual harassment has been filed with the Title IX Coordinator. The Board has an informal resolution process to promptly and equitably resolve such complaints using mediation [alternatively, could be restorative justice]. This informal resolution process will only be utilized if both the Complainant and Respondent agree to do so.
The conduct allegedly constituting sexual harassment:_____________________________________________________________________________________________________
_______________________________________________________________________________________________________________
If both parties agree to the informal resolution process, it shall preclude the parties from resuming a formal complaint arising out of the same allegations. However, either party may withdraw from the informal resolution process at any time before agreeing to a resolution and resume the grievance process for formal complaints of sexual harassment.
If both parties agree to a resolution, that resolution is binding upon both parties and cannot be changed or appealed.
The District will maintain for a period of seven (7) years records of the informal resolution process and results therefrom.
________________________________________________________________
I voluntarily consent to the informal resolution process:
_______________________________ _______
Complainant Date
_______________________________ _______
Parent/Guardian of Complainant Date
_______________________________ _______
Respondent Date
_______________________________ _______
Parent/Guardian of Respondent Date