Complaint/Anonymous Contact
Name (optional, but this will only serve as a notification and cannot proceed through the grievance process if anonymous)
Email (optional, but you may not be notified of the outcome if anonymous)
Phone (optional, but you may not be notified of the outcome if anonymous)
Today's Date
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If this is an emergency please call 911. If you need immediate supportive measure please contact a member of staff/admin directly. Grievance reason:
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Sexual assault or harassment, or other sex or gender based discrimination
Discrimination related to race, ethnicity, citizenship, religion, or other legally protected groups
Violation of student, staff, or faculty handbooks or other ACCHS policies
Other discrimination or concern, or unsure
Date of Most Recent Incident
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Approximate time of incident
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Location of incident
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Who complaint is against/Person(s) involved
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Person(s)'s relationship to the school
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Witnesses' name(s) and email address(es), if applicable
The nature of your complaint or a description of the incident:
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Any previous incidents with the same individual/party:
Please let us know the outcome or resolution you would like to see. For more information on ACCHS' grievance processes, visit https://docs.google.com/document/d/17947_ZB_AJNUEX_qOGC5oW1ByUSJBCF1HYHow_NZkPY
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