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