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Harassment / Discrimination Complaint Submission Form (Electronic Version)
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Harassment / Discrimination Complaint Submission Form (Electronic Version)
Harassment / Discrimination Complaint Submission Form (Electronic Version)

The Office of Equality & Civil Rights is tasked with working collaboratively in enforcing non-discrimination and equal treatment for all our students, employees, parents and other stakeholders. You may use this form to report incidents of possible discrimination or harassment. For a printable version of the complaint form, please see the Resources section.

*(Required fields displayed in red with asterisks)

Full name: 
Contacting party is:
Student's name: 
Job title (If MPS staff): 
Place of employment/school: 
Supervisor/Principal: 
Primary phone number:  
Email: 
Mailing address (street, city, state, zip): 
Gender:
Race/Ethnicity:
Date(s) of Alleged Incident: 
Type of complaint:
I feel that I was discriminated/sexually harassed or assaulted/retaliated against as follows: