San Diego Unified School District Sexual Harassment Complaint Form

If there is an immediate threat or safety concern, contact SDUSD Police at (619) 291-7678.

IF YOU ARE IN IMMEDIATE DANGER, CALL 911.

Person Filing Complaint

Are you a.....?

Full Name

Address

Apt. #

City

State & Zip Code

Phone Number

Alt. Phone Number

Email Address

Alleged Victim(s)

Is the alleged victim a ....?

Full Name

Is the address for this person the same as the person filing the complaint?

Phone Number

Alt. Phone Number

Email Address

Are there more alleged victims involved?

Factual Details

Name(s) of Accused

Please also include if the accused is a student, employee or other.

i.e. John Doe, Student

School/Location

School Program/Activity

Date of the Incident(s)

Frequency of the Incident(s)

Is the alleged victim currently participating in any District programs or activities?

Known Witness(es)

Please include if the witness is a student, employee, parent/guardian or other.

i.e. Jane Doe, Parent

Incident/Conduct

Please review the Title IX definitions before completing.

Do you believe this incident or conduct is Title IX misconduct?

Outcome

What is the outcome/resolution you desire from filing this complaint?

Supportive Measures

Have Supportive Measures been implemented for the alleged victim?

Please list any Supportive Measures already in place.

Would you like to request (additional) Supportive Measures?

Send me a copy of my responses