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Title IX Complaint Form

The District complies with the Civil Rights Laws, including but not limited to Title IX of the Education Amendments of 1972. It is the express policy of the board of education to encourage student victims of sexual harassment to come forward with such claims.

Students who feel that administrators, supervisors, support personnel, teachers, or other students are subjecting them to sexual harassment are encouraged to report these conditions or have their parents report these conditions, to the Title IX Coordinator. Any employee to whom such a report was made will provide notice of the report to the Title IX coordinator.

Title IX complaints can be submitted by contacting the Title IX Coordinator in person, by mail, by phone, by submitting this form, or by email at the contact information provided below:

Mark Officer
Assistant Superintendent
Address: 1501 North Ash Street
Owasso, OK 74055
Phone: (918)272-5367
Email: [email protected]

COMPLAINANT'S PERSONAL INFORMATION

First and Last Name (Legal)*

Answer Required

Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Cell Phone Number*

Number Required

Email Address*

Answer Required

RESPONDENT'S INFORMATION
Please list the individual(s) alleged to have engaged in sexual harassment/prohibited conduct.

Respondent's Name #1*

Answer Required

Respondent's School/Department*

Answer Required

Respondent's Name #2

Answer Required

Respondent's School/Department

Answer Required

Respondent's Name #3

Answer Required

Respondent's School/Department

Answer Required

COMPLAINANT'S PERSONAL INFORMATION

Type of Complaint*

Answer Required

Sexual Harassment

Sexual Assault

Gender Based Harassment

Dating Violence

Stalking

Retaliation

Cyber Bullying

Other

Dates Incident(s) Occurred

Earliest*

Answer Required

Latest

Skip to other if ongoing

Answer Required

Other

Answer Required

Inappropriate actions ongoing

NATURE OF COMPLAINT*

Please specifically describe your complaint against the named person(s) in the previous section, including how the person(s) sexually harassed you, or retaliated against you. Please describe the behavior, comments, or incidents that caused you to file your complaint. (Identify: Who, What, When, and Where)

Answer Required

WITNESS INFORMATION
Please identify witnesses to the incident(s) or those who have knowledge of the incident(s).
Please attach additional names if needed.

Witness Name #1

Answer Required

Relationship to you

Answer Required

Phone Number

Number Required

Email Address

Answer Required

Witness Name #2

Answer Required

Relationship to you

Answer Required

Phone Number

Number Required

Email Address

Answer Required

Did you discuss this matter with any of the witnesses previously identified? If yes, please provide the name of the witness, the date you spoke with them, and the method of communication (i.e. in-person, by phone, email, text, etc.).

Answer Required

Please identify any OPS administrators, employees, or law enforcement agency to whom you have reported your concerns.

Answer Required

By typing your name here, you attest that the information provided above is correct and accurate.

Complainant Full Name*

Answer Required

Date*

Answer Required

Confirmation Email

Confirmation Email *

Email Required