AC-TCA-F2: Staff or Student Sexual Harassment Appeal Form
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Is this an appeal for a staff member or student?
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Staff Member
Student
Staff Name
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Parent Name
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Student Name
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Email Address
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I spoke/met with the appropriate school administrator
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Yes
No
N/A
Name of school administrator contacted
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Date spoke/met with school administrator
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Must contain a date in MM/DD/YYYY format
Choose the appropriate school:
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Central Elementary
College Pathways
Cottage School
East Elementary
High School
High School Athletics
Junior High
Junior High Athletics
North Elementary
I spoke/met with the appropriate Administrator/Decision Maker
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Yes
No
N/A
Name of Administrator/Decision Maker contacted
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Date spoke/met with Administrator/Decision Maker
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Must contain a date in MM/DD/YYYY format
Date of final Findings Report
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Must contain a date in MM/DD/YYYY format
Date Conflict Occured
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Must contain a date in MM/DD/YYYY format
What is/are the grounds for the appeal?
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Please select up to 3 choices
Procedural irregularity that affected the outcome of the grievance process;
New evidence that was not reasonably available at the time of the determination, regarding the existence of a policy violation, was discovered that could affect the outcome of the grievance process; and/or
The Title IX Coordinator, the Investigator, or the Decision Maker had a conflict of interest or bias that affected the outcome of the grievance process.
Please select up to 3 choices
Basis for Claim and Relief Sought
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Do you dispute the policy?
Do you dispute the facts?
Do you dispute how the policy was applied with the facts?
Briefly explain your claim
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0 / 2500
Briefly explain the result you are seeking
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0 / 2500
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