SUFFIELD PUBLIC SCHOOLS
Discrimination Grievance Form
Any student, parent/guardian, employee or employment applicant who feels that he/she has been discriminated against on the basis of race, color, age, national origin, marital status, sex, sexual orientation, gender identity or expression, or disability may discuss and/or file a grievance with the Title IX Coordinator of the Suffield Public Schools. Reporting should take place 40 calendar days of the alleged discrimination. Title IX Coordinator:
Assistant Superintendent of Curriculum and Instruction
Name of Presenter/Complainant:_________________________________
Employee ___ Employment Applicant ___ Student ___ Parent/Guardian___
Home address ________________________________________________
Phone ____________ Date of Claim _______ Date of Incident _________
- Statement of Incident/Issue (include all pertinent information: who, how, where, when, how often, feelings, witness).
- Please attach any additional information/documentation as necessary.
Signature of Presenter: _______________________________
Signature of Title IX Coordinator: _______________________
Date Received: _____________________________________
Forms are available from the Title IX Coordinator,
Administrators and Guidance Offices.
Download the PDF of this Form