MSDWT Complaint Form - Online Submission

MSDWT Complaint Form - Online Submission

Instructions

Please use this form to submit a formal complaint about an incident in our schools. MSDWT encourages all staff, parents, students and stakeholders to report issues of concern so they may be investigated. Your submission will be electronically routed to the appropriate party. Please complete this form to the best of your ability. Report only one incident per form.

Does the incident involve concerns about the actions of a staff member?*

Select

Does the incident involve concerns about the actions of a student?*

Select

Please indicate if the incident or concern involves concerns related to:*

Select

If you answered "other" to the question above, please indicate the nature of the concern.*

Background Information

Would you like to submit your concern anonymously? (If you check Yes below, please know that the School Corporation will make reasonable efforts to protect the privacy of those involved including witnesses to the extent possible, but cannot promise confidentiality given the School Corporation’s legal obligations to investigate, take appropriate action, and comply with any disclosure obligations mandated by law. Anonymous complaints may limit our ability to conduct a thorough investigation.)

I would like to submit this information anonymously.*

Select

Role of the Person Submitting Form*

Select

Other*

Name of the Person Submitting Form*

Contact Email

Contact Phone Number

Phone

Contact Street Address

Contact City

Contact State

Contact Zip Code

Involved Parties

Name of Person you feel acted inappropriately:*

Role of person acting inappropriately:*

Select

If you answered "Other" above, please describe .*

Staff Position*

Coach Sport*

Name of Person you feel may have been harmed:*

Role of person that may have been harmed*

Select

If you answered "Other" above, please describe.*

Incident Information

Location of Alleged Incident*

Please include exact location (building, room, sporting event, electronic communication, etc.)

Date Incident Occurred*

If multiple dates of occurrence, please provide an approximate date range

Time of Incident*

Please include a.m. or p.m.

To your knowledge has anyone notified law enforcement or the Department of Child Services about this incident?*

Select

If you answered "Yes" above, please describe.*

Include all available information, such as Name of Agency (IMPD, DCS, etc.); Date; Time and Name of Person reporting, if known.

Please describe the incident in as much detail as possible using specific, concise, objective language (who, what, where, when, why, and how).*

Send me a copy of my responses

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