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Complaint Form

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CRESCENT SCHOOL DISTRICT #313

P. O. Box 20

Joyce, WA 98343

COMPLAINT FORM

Crescent School District is committed to preventing harassment in any of its forms on campus. To ensure fairness and consistency, procedures have been established by the District regarding any harassment complaint. Please respond to the questions below providing as much detail as possible.

Name(s)

Answer Required

Address (es)

Answer Required

Telephone Number (s)

Answer Required

Please attach additional sheets if necessary to answer questions 2, 3 and 4

Nature of complaint, including the description of the grounds of the complaint with all names, dates, and places necessary for a complete understanding of the complaint

Answer Required

What resolution or redemption do you request?

Answer Required

Has this matter been discussed with the offender?

Yes Or No

Answer Required

Has this matter been discussed with an adult other than the offender?

Yes Or No

Answer Required

If yes, list the names, dates and results of the discussion (s)

Answer Required

I (we) understand that the School District may request from me (us) further information about this complaint, and if such information is available, I (we) shall present it upon requestxt

I (we) certify under penalty of perjury that the foregoing is true and correct

Signature*

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Confirmation Email

Confirmation Email *

Email Required