Boulder Valley School District
Adopted: May 8, 2007
Revised: October 23, 2012, February 8, 2022, August 26, 2025
Fill out the Complaint/Grievance Online Form
NONDISCRIMINATION/EQUAL OPPORTUNITY
(COMPLAINT/GRIEVANCE FORM)
Date of Report: _______________
Do you wish to remain anonymous: □ Yes □ No
If not proceeding anonymously, name of Reporting Party (Complainant): __________________________________
If not proceeding anonymously, Reporting Party's (Complainant) email address: _______________________________________________
Reporting Party Information:
□ I am the person who experienced the misconduct.
□ I am reporting conduct I observed.
□ I am reporting conduct that I heard about from another person.
I would like the report:
□ To be investigated.
□ To be used for informational purposes only
□ I am not sure
Date of the incident: _________________
Name(s) of school, department, and person(s) involved:
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Why do you believe this incident occurred? Choose all that apply.:
□ Age
□ Ancestry/National origin
□ Citizenship status/Immigration status
□ Disability
□ Sex/Gender
□ Gender identity or expression
□ Socioeconomic Status
□ Race/Ethnicity/Creed/Color
□ Religion
□ Sexual Orientation
□ Family Composition
□ Physical Characteristics
□ Genetic Information
□ Pregnancy/Childbirth
Description of the incident:
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Did anyone witness the incident? □ Yes □ No
Name(s) of witnesses to the incident:
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Have you reported the incident to other BVSD staff? If so, please list name(s) and response:
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If others are affected by the possible discrimination or harassment, please give their names:
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What would your ideal course of action to address the incident be?:
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Do you wish to be contacted? □ Yes □ No
Is there anything else you would like to share regarding this incident?
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