Equity Complaint Form

Equity Complaint Form

First name:  Last Name: 

E-mail: 

Address:

City:  Zip Code:  Phone: 


What do you believe was the reason for the discriminatory or harassing treatment?

 Race or Color
 Religion
 Handicap
 Sex
 National Origin
 Age
Other: 


Check one that Applies:

 Student
School:  Grade: 

 Employee
School/Department:  Position: 


Have you filied this compliant with any other agency?

 No
 Yes (If yes, Name of agency and date filed)
Name:  Date: 


Explain the dicriminatory or harassing act that occured. If the complaint involves a policy, explain how and why it discriminates. A short statement in your own words is sufficent, however, you may email more information and documents if necessary to AndrewSB@leeschools.net

By typing your name in the "Full Name" field:
"I swear or affirm that I have read the above complaint and that it is true to the best of my knowledge and belief."

Full Name:  Date:



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