Title IX Formal Complaint Form

The purpose of this form is to gather the essential facts surrounding your allegations. Should you have questions about this form or the information to be provided, please contact the District's Title IX Coordinator, at 419-334-5464 or 419-334-5433.

I am a complainant filling out this form as a/an:

A form will populate here based on your choice above

Your Information

First name:

Middle initial:

Last name:

Suffix:

Address:

City:

State:

Zip code:

Phone number:

Email address:

A district building you are employed at:

Relationship to involved parties:

Incident Information

Was this incident already reported to a district staff member?

Yes

Approximate date and time of the incident:

Incident Location:

Individual(s) involved in the incident:

Were there other witnesses to the incident?

Yes

Details of the incident:

Do you have additional documentation (images, text, audio, etc.) regarding the incident?

Yes

Acknowledgement

By checking this box, you are indicating that the information you are providing in the above form is true and accurate to the best of your knowledge.