Date of complaint:__________________________________________________________________________

Name of complainant: ______________________________________________________________________

Are you filling out this form for yourself of someone else (please identify the individual you are submitting on behalf of someone else):  ______________________________________________

Who or what entity do you believe discriminated against, harassed, or bullied you (or someone else)?

______________________________________________________________________________

Name of alleged harasser or bully:_____________________________________________________________

Date and place of incident or incidents:_________________________________________________________

________________________________________________________________________________________

Name of witnesses (if any):___________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Nature of alleged discrimination, harassment, or bullying (check all that apply):
_____Age                                                          _____Physical Attribute                                  _____Sex                                    _____Disability                                  _____Sexual Orientation                                   _____Physical/Mental Ability                          _____Gender Identity                  _____Familial Status                                    _____Socio-economic Background                   _____ Political Belief                                      _____Marital Status                     _____Political Party Preference                 _____Race/Color                                               _____Religion/Creed                                      _____National Origin/Ethnic Background/Ancestry                       _____Other – Please Specify: ___________________________________________

Please describe what happened and why you believe you or someone else has been discriminated against, harassed or bullied. Please be as specific as possible, attaching additional pages if necessary:______________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Evidence of harassment or bullying, i.e., letters, photos, etc. (attach evidence if possible): 

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

Signature:______________________________________________________                                        Date: _____ /_____ /_____

 

Name of witness:____________________________________________________________________________

Position of witness:___________________________________________________________________________

Date of testimony, interview:____________________________________________________________________

Date on initial complaint:  ______________________________________________________________________

Name of Complainant (Include whether the Complaintant is a student or employee): ________________________

___________________________________________________________________________________________

Date and place of alleged incident(s):  _____________________________________________________________

___________________________________________________________________________________________

Nature of alleged discrimination, harassment, or bullying (check all that apply):
_____Age                                    _____Physical Attribute                                  _____Sex                            _____Disability                            _____Sexual Orientation             _____Physical/Mental Ability                          _____Gender Identity                                               _____Familial Status                   _____Socio-economic Background                _____ Political Belief.          _____Marital Status                    _____Political Party Preference  _____Race/Color                                             _____Religion/Creed
_____National Origin/Ethnic Background/Ancestry             _____Other – Please Specify:________________

 

Description of incident witnessed:________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Any other information:__________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge.

Signature: ______________________________________________

Date: ____/____ /____

Date:  _____________________________________________________

Date of initial complaint: ___________________________________________

Name of Complainant (include whether the Complainant is a student or employee): 

_____________________________________________________________________________________________  _____________________________________________________________________________________________

Date and place of alleged incident(s):_______________________________________________________________________ _____________________________________________________________________________________________________  _____________________________________________________________________________________________________

Name of Respondent (include whether the Respondent is a student or employee): _____________________________________________________________________________________________________  _____________________________________________________________________________________________________

Nature of alleged discrimination, harassment, or bullying (check all that apply):
_____Age                                   _____Physical Attribute                                  _____Sex                            _____Disability                            _____Sexual Orientation            _____Physical/Mental Ability                          _____Gender Identity                                                   _____Familial Status                  _____Socio-economic Background                _____ Political Belief
_____Marital Status                    _____Political Party Preference                     _____Race/Color                                                               _____Religion/Creed.                  _____National Origin/Ethnic Background/Ancestry                                                                      _____Other – Please Specify: ____________________________________________________

 

Summary of Investigation: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

Signature: _____________________________________Date:  ___________________

General Procedures

Individuals who feel that they have been harassed should:

• tell a teacher, counselor, principal, or another appropriate school employee; and

• write down exactly what happened, keep a copy and give another copy to the teacher, counselor, principal, or another appropriate school employee including;

• What, when and where it happened;

• Who was involved;

• Exactly what was said or what the harasser did;

• Witnesses to the harassment;

• What the student said or did, either at the time or later;

• How the student felt; and

• How the harasser responded.

Filing a Complaint

An individual who believes that the individual has been harassed or bullied will notify the building principal or designee, who will be the designated investigator. The alternate investigator is the Superintendent or Superintendent’s designee.  The investigator may request that the individual complete the Harassment/Bullying Complaint form (located at this link or in the district office) and turn over evidence of the harassment, including, but not limited to, letters, tapes, or pictures. The complainant shall be given a copy of the completed complaint form. Information received during the investigation is kept confidential to the extent possible. The investigator has the authority to initiate an investigation in the absence of a written complaint.

If the complainant is a school employee, after filing the complaint with the Superintendent or Superintendent’s designee, the employee may separately notify the parent or guardian of the student alleged to have been harassed or bullied.

An alternate investigator will be designated in the event it is claimed that the Superintendent or Superintendent’s designee committed the alleged bullying or harassment or some other conflict of interest exists.  Complaints shall be filed within 180 days of the event giving rise to the complaint or from the date the Complainant could reasonably become aware of such occurrence.  The Complainant will state the nature of the complaint and the remedy requested. The Complainant shall receive assistance as needed. 

Investigation 

The school district will reasonably and promptly commence the investigation upon receipt of the complaint. The building principal or designee (hereinafter “Investigator”) will be responsible for handling all complaints alleging bullying or harassment.

The investigation may include, but is not limited to the following: 

• Interviews with the Complainant and the individual named in the complaint (“Respondent”)

• A request for the Complainant to provide a written statement regarding the nature of the complaint; 

• A request for the Respondent to provide a written statement; 

• Interviews with witnesses identified during the course of the investigation; 

• A request for witnesses identified during the course of the investigation to provide a written statement; and 

• Review and collection of documentation or information deemed relevant to the investigation. 

The Investigator shall consider the totality of circumstances presented in determining whether conduct objectively constitutes bullying or harassment as defined in Board policy. Upon completion of the investigation, the investigator will make written findings and conclusions as to each allegation of harassment and report the findings and conclusions to the Superintendent. The investigator will provide a copy of the findings of the investigation to the Superintendent.

Remember the following points:

• The complaint and identity of the Complainant, Respondent, or witnesses will only be disclosed as reasonably necessary in connection with the investigation or as required by law or policy

•  Evidence uncovered in the investigation is kept confidential to the extent reasonably possible;

•  Complaints must be taken seriously and investigated;

•  No retaliation will be taken against individuals involved in the investigation process; and

•  Retaliators will be disciplined up to and including suspension and expulsion.

Conflicts with Investigation

If the investigator is a witness to the incident, the alternate investigator shall investigate.

Resolution of the Complaint

Following receipt of the investigator's report, the Superintendent may investigate further, if deemed necessary, and make a determination of any appropriate additional steps which may include discipline.

Prior to the determination of the appropriate remedial action, the Superintendent may, at the Superintendent’s discretion, interview the complainant and the alleged harasser. The Superintendent will file a written report closing the case and documenting any disciplinary action taken or any other action taken in response to the complaint. The complainant, the alleged harasser and the investigator will receive notice as to the conclusion of the investigation. The Superintendent will maintain a log of information necessary to comply with Iowa Department of Education reporting procedures.

If, after an investigation, a student is found to be in violation of the policy, the student shall be disciplined by appropriate measures, which may include suspension and expulsion.  If after an investigation a school employee is found to be in violation of this policy, the employee shall be disciplined by appropriate measures, which may include termination.  If after an investigation a school volunteer is found to be in violation of this policy, the volunteer shall be subject to appropriate measures, which may include exclusion from school grounds. 

 

Individuals who knowingly file false bullying and/or harassment complaints and any person who gives false statements in an investigation may be subject to discipline by appropriate measures, as shall any person who is found to have retaliated against another in violation of this policy.  Any student found to have retaliated in violation of this policy shall be subject to measures up to, and including, suspension and expulsion.  Any school employee found to have retaliated in violation of this policy shall be subject to measures up to, and including, termination of employment.  Any school volunteer found to have retaliated in violation of this policy shall be subject to measures up to, and including, exclusion from school grounds.  

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Approved: 5/13/13                              Reviewed: 8/8/2016                                 Revised: 8/8/2016; 6/10/19; 12/9/24

I.     Initiations, Hazing, Bullying or Harassment

Harassment, bullying and abuse are violations of District policies, rules and regulations and, in some cases, may also be a violation of criminal or other laws. The District has the authority to report students violating this rule to law enforcement officials.

Harassment and bullying may include, but are not limited to, the following behaviors and circumstances:

• Verbal, nonverbal, physical or written harassment, bullying, hazing, or other victimization that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim;

• Repeated remarks of a demeaning nature that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim;

• Implied or explicit threats concerning one's grades, achievements, property, etc. that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim;

• Demeaning jokes, stories, or activities directed at the student that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim; and/or

• Unreasonable interference with a student's performance or creation of an intimidating, offensive, or hostile learning environment.

Sexual harassment means unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature when:

• Submission to the conduct is made either implicitly or explicitly a term or condition of the student’s education or benefits;

• Submission to or rejection of the conduct by a school employee is used as the basis for academic decisions affecting that student; or

• The conduct has the purpose or effect of substantially interfering with the student’s academic performance by creating an intimidating, hostile, or offensive education environment.

• In situations between students and school officials, faculty, staff, or volunteers who have direct contact with students, bullying and harassment may also include the following behaviors:

• Requiring that a student submit to bullying or harassment by another student, either explicitly or implicitly, as a term or condition of the targeted student’s education or participation in school programs or activities; and/or

• Requiring submission to or rejection of such conduct as a basis for decisions affecting the student.

Harassment and bullying includes any electronic, written, verbal, or physical act or conduct toward a student which is based on any actual or perceived trait or characteristic of the student and which creates an objectively hostile school environment that meets one or more of the following conditions:

• Places the student in reasonable fear of harm to the student’s person or property;

• Has a substantially detrimental effect on the student’s physical or mental health;

• Has the effect of substantially interfering with the student’s academic performance; or

• Has the effect of substantially interfering with the student’s ability to participate in or benefit from the services, activities, or privileges provided by a school.

“Electronic” means any communication involving the transmission of information by wire, radio, optical cable, electromagnetic, or other similar means. “Electronic” includes but is not limited to communication via electronic mail, internet-based communications, pager service, cell phones, electronic text messaging or similar technologies.

 

II.     Procedures

Students who feel that they have been harassed or bullied should:

• tell a teacher, counselor, principal or another appropriate school employee; and

• write down exactly what happened, keep a copy and give another copy to the teacher, counselor, principal or another appropriate school employee including:

  • What, when and where it happened;

  • Who was involved;

  • Exactly what was said or what the harasser did;

  • Witnesses to the harassment;

  • What the student said or did, either at the time or later;

  • How the student felt; and

  • How the harasser responded.

 

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