Uniform Complaint Reporting Form

In accordance with the District’s Uniform Complaint Procedures (5 CCR 4620) each school district shall follow uniform complaint procedures when addressing complaints alleging unlawful discrimination against any protected group. Protected groups put forth under Title IX and in California are enumerated by Education Code §§ 200 and 220, Government Code §11135, and include actual or perceived sex, sexual orientation, gender, ethnicity, race, ancestry, national origin, religion, color, mental or physical disability, and age, as well as association with member of a protected class. Additionally, it is the policy of the State of California, pursuant to Section 200, that all persons should enjoy freedom from discrimination and/or harassment of any kind in the educational institutions of the state. This also includes sexual harassment, which is a form of sexual discrimination (EC § 231.5).

Required fields marked with an asterisk *

I. Contact Information:

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Email*

Answer required for "Email"

Mobile Phone*

Number Required

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

II. Complainant

You are filing this complaint on behalf of:*

Answer required for "You are filing this complaint on behalf of:"

Yourself

Your Child or a Student

Another Student

A Group

III. School Information

School Name*

Answer required for "School Name"

Mammoth High School

Mammoth Middle School

Mammoth Elementary School

Sierra High School

IV. Basis of Discrimination or Harassment:

*According to state law, “‘Gender’ means sex, and includes a person's gender identity and gender related appearance and behavior whether or not stereotypically associated with the person's assigned sex at birth.” CA Education Code § 210.7 & CA Penal Code § 422.56(c).

V. Details of Complaint

Please answer the following questions to the best of your ability.

Please describe the type of harassment or discrimination that you experienced, including the events or actions, in as much detail as possible: *

Answer required for "Please describe the type of harassment or discrimination that you experienced, including the events or actions, in as much detail as possible: "

List the people involved in harassing or discriminating against you: *

Answer required for "List the people involved in harassing or discriminating against you: "

List any witnesses of the incident: *

Answer required for "List any witnesses of the incident: "

Describe the location where the harassment/discrimination occurred: *

Answer required for "Describe the location where the harassment/discrimination occurred: "

Please list all the date(s) and times when the harassment/discrimination occurred or when the alleged harassment/discrimination first came to your attention:*

Answer required for "Please list all the date(s) and times when the harassment/discrimination occurred or when the alleged harassment/discrimination first came to your attention:"

What steps, if any, have you taken to resolve this issue before filing a complaint?*

Answer required for "What steps, if any, have you taken to resolve this issue before filing a complaint?"

VI. Signature

Signature of Person Filing Complaint*

Signature Required

Please fix the highlighted areas below before submitting.

Uniform Complaint Reporting Form