Policies » Section G: Personnel » GBAA-R: Sexual Harassment And Sexual Violence Report Form
Policy Date: 06/15/2021Download Policy Now
HSD File: GBAA-R
HOOKSETT SCHOOL DISTRICT
SEXUAL HARASSMENT AND SEXUAL VIOLENCE
General Statement of Policy Prohibiting Sexual Harassment
The school district maintains a firm policy prohibiting all forms of discrimination based on sex. Sexual harassment and sexual violence against students or employees is sex discrimination. All persons are to be treated with respect and dignity. Sexual violence, sexual advances or other forms of personal harassment by any person, male or female, which create an intimidating, hostile or offensive environment will not be tolerated under any circumstances.
Date of Alleged Incident(s):________________________________
Name of person you believe sexually harassed or was sexually violent toward you:______________________________________
List any witnesses that were present:_________________________________________________________________
Where did the incident(s) occur?:____________________________________________________________________
Describe the incident(s) as clearly as possible, including such things as: what force, if any was used; any verbal statements (i.e., threats, requests, demands, etc.); what, if any, physical contact was involved; what did you do to avoid the situation, etc. (Attach additional pages if necessary):_____________________________
This complaint is filed based on my honest belief that_____________________________________________________
has sexually harassed or was sexually violent to me. I hereby certify that the information I have provided in this complaint is true, correct, and complete to the best of my knowledge and belief.
Complainant’s Signature_____________________________ Date_________________________
Received by______________________________________ Date____________