Complaint Form Home Complaint Form Complaint Form Title IX Complaint Form Complaint FormName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone(Required)Email(Required) Enter Email Confirm Email Please select your title(Required)Community MemberEmployeeParentStudentsSchool Building where complaint should be directed(Required)CM Elementary SchoolCM Jr/Sr High SchoolCM District OfficeHave you talked to the building principal or immediate supervisor to try to resolve the problem?(Required) Yes No If the conduct involves your principal or immediate supervisor, have you followed the chain of command and contacted that person's immediate supervisor?(Required) Yes No Do you understand the statement below?(Required) Yes No You are required to cooperate fully with any investigation conducted by Colfax-Mingo Community School District. You may not knowingly file a false complaint. If you knowingly provide untruthful or inaccurate statements, you may be subject yourself to disciplinary action, up to and including termination.Do you understand the statement below?(Required) Yes No Retaliation against any person, because the person has filed a complaint or assisted or participated in an investigation, is prohibited. Persons found to have engaged in retaliation shall be subject to discipline by appropriate measures.Did you file a complaint?(Required) Yes No Against who?(Required) Enter the name in this box aboveDo you need to add another person to your complaint?(Required) Yes No The allegation is:(Required)Please be specific and detailed in your answer.On what basis?(Required)DiscriminationBullying/Harassment (Students Only)Sexual HarassmentHostile Work Environment (Employee Only)Section 504 ViolationNature of discrimination, harassment, or bullying (check all that apply )(Required) Age Disability Familial Status Gender Identity Martial Status National Origin/Ethnic Background/Ancestry Physical Attribute Physical/Mental Ability Political Belief Political Party Preference Race/Color Religion/Creed Sex Sexual Orientation Socioeconomic Background Title IX Other When did this alleged treatment begin?(Required) MM slash DD slash YYYY Type your full name(Required) First Last Consent(Required) I agree that the above statements are true.CAPTCHA District Policies: 102 Equal Educational Opportunity 401.01 Equal Employment Opportunity 104 Harassment Inappropriate Student Interaction Complaint Form
