You are here

500.2 Exhibit C – Summary of Disposition of Student Discrimination, Harassment or Bullying Complaint

 

Code No. 500.2

Exhibit C

SUMMARY OF DISPOSITION OF STUDENT DISCRIMINATION,

HARASSMENT OR BULLYING COMPLAINT

(SEE FORM ATTACHED)

 

Name of Complainant:         _______________________________________________                                                                                                              

Name of Student:                 ________________________________________________                                                                                                               

Grade and Building of Student:     _____________________________________________                                                                                                    

Name and Position of Alleged Perpetrator/Respondent:  ______________________________                                                                 

 Date of Initial Complaint     ______________________________________________________                                                                                                                

Nature of Discrimination or Harassment Alleged:

                                    Race, Color                                                      Marital Status

                                    Sex                                                                   Familial Status

                                    Sexual Orientation                                           Gender Identity

                                    Religion, Creed                                                 Disability or Ability

                                     National Origin/Ethnic                                      Physical Attribute

                                    Background/Ancestry              

                                    Political Preference                                         Other                                      

                                    Socio-Economic Background   

 

 

Summary of Investigation:

  

 

 

 

 

Conclusion:                 

_______    Founded  (The totality of the evidence reasonably demonstrates the actions occurred and arose to the level of discrimination or harassment.)                                                                                                           

_______   Unfounded              

 _______  Inconclusive

 

___________________________________________________                                                                                

Signature 

___________________________________________________                                                                                 

Typed or Printed Name 

 __________________________________________________                                                                              

  Position 

___________________________________________________                                                                                 

Address 

___________________________________________________                                                                               

Date

 

Copies to:Student’s Parent or Guardian, Alleged Perpetrator/Respondent, Superintendent

Date of Last Review:  October 14, 2019 /Form Revised:   December 14, 2015