Uniform Complaint Procedure Discrimination/Harassment Complaint Reporting Form (For students, employees, parents or guardians of students, school and district advisory committees, appropriate private school officials or representatives, and other interested parties) The Sweetwater Union High School District has the primary responsibility to ensure compliance with applicable state and federal laws and regulations and has established procedures to address allegations of unlawful discrimination, harassment, intimidation, and bullying and complaints alleging violation of state or federal laws governing educational programs and the charging of unlawful pupil fees. The Sweetwater Union High School District shall investigate and seek to resolve complaints using policies and procedures known as the Uniform Complaint Procedures (UCP) adopted by our local board. Unlawful discrimination, harassment, intimidation, or bullying complaints may be based on actual or perceived age, ancestry, color, disability, ethnic group identification, gender expression, gender identity, gender, nationality, national origin, race or ethnicity, religion, sex, sexual orientation, or on a person’s association with a person or group with one or more of these actual or perceived characteristics, in any program or activity that receives or benefits from state fina ncial assistance. The UCP shall also be used when addressing complaints alleging failure to comply with state and/or federal laws in the following programs: Adult Education, Consolidated Categorical Aid Programs, Migrant Education, Career Technical and Technical Education and Training Programs, Child Care and Development Programs, Child Nutrition Services, Local Control Funding Formula Programs, Local Control Accountability Plan Implementation Process (LCAP), Special Education Programs, and Safety Planning Requirements Complaints of noncompliance with laws relating to pupil fees are filed with the principal of a school. A complaint regarding pupil fees may be filed anonymously if the complaint provides evidence or information to support an allegation of noncompliance with laws relating to pupil fees. A pupil fee complaint shall not be filed later than one year from the date the alleged violation occurred.

I. Contact Information: Name: ______________________________________________________________________ Address: ____________________________________________________________________ City: ______________________________________________Zip:_______________________ Home Phone: _______________________ Work or Cell Phone: ________________________ II. Complainant: You are filing this complaint on behalf of: ___________________________________________ □ yourself □ your child or a (student) □ another student □ a group

III. School Information: School Name: _______________________________________________________________ Principal’sName:_____________________________________________________________ Address: ________________________________________City:_________________________ IV. Basis of Complaint: Please check the following box(s), based on the type(s) of discrimination, harassment, intimidation bullying, or the imposition of unlawful and impermissible student fees you may have experienced. (Education Code §§ 200 and 220)

categories

V. Details of Complaint Please answer the following questions to the best of your ability. Attach additional sheets of paper if you need more space.

Please describe the type of incident(s) you experienced that led to this complaint, including the events or actions, in as much detail as possible: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

List the individuals involved in the incident(s) complaint of: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ List any witnesses to the incident(s): ______________________________________________________________________ ______________________________________________________________________ Describe the location where the incident(s) occurred: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please list all the date(s) and times when the incident(s) occurred or when the alleged acts first came to your attention: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ What steps, if any, have you taken to resolve this issue before filing a complaint? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ __________________________________ Signature of person filing complaint

_____________________ Date

Received by: Title:

Date Filed:

Copies free of charge Response to Dissatisfied UCP Decision If dissatisfied with the district's decision, the complainant may appeal in writing to the CDE within 15 days of receiving the district's decision. When appealing to the CDE, the complainant must specify the basis for the appeal of the decision and whether the facts are incorrect and/or the law has been misapplied. The appeal shall be accompanied by a copy of the locally filed complaint and a copy of the district’s decision. (5 CCR 4632). To file an appeal, write to: California Department of Education Office of Education Equity 1430 N Street, Suite 4206 Sacramento, California 95814