DKB-1
| Policy Exhibit #1 | DKB |
Report of Sexual Harassment
This form shall be maintained as confidential by the District within the limitations outlined in policy.
Name: __________________________________
Home Telephone Number: __________________
Street Address: ___________________________
Employment Position: _____________________
School: _________________________________
Street Address: ___________________________
The particulars are (if additional space is needed, attach extra sheets): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Persons Involved: ________________________________________________________________________________________________________________________________
Description of dates, places and nature of sexual harassment: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Witnesses (if any): ________________________________________________________________________________________________________________________________
___________________________
Signature of Complaining Person
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