Editing previous response:

Please fix the highlighted areas below before submitting.

Sexual Harassment/Discrimination Form

Please complete the form below. Required fields marked with an asterisk *

Name *

Answer Required

Job Title*

Answer Required

Work Address

Answer Required

Work Phone*

Answer Required

Email*

Answer Required

Your complaint of Sexual Harassment is made about:*

Answer Required

Please describe what happened and how it is affecting you and your work. Please send any relevant documents or evidence to kmcgaha@okolona.k12.ms.us*

Answer Required

Date(s) sexual harassment occurred:*

Answer Required

Please list the name and contact information of any witnesses or individuals who may have information related to your complaint:

Answer Required

Optional: Have you previously complained or provided information verbal or written about related incidents? If yes, when and to whom did you complain or provide information?

Answer Required

If you have retained legal counsel and would like us to work with them, please provide their contact information

Answer Required

Confirmation Email

Email Required