Title IX Reporting Form - Colonial School District

Name of Person Filing Complaint

First Name

Last Name

Street Address

City, State, Zip Code

Note: You will be contacted further to discuss the complaint. Please understand that if you wish to remain anonymous, you may.

Please be advised that the required email address below doesn't need to be your regular email address. If you'd like to remain anonymous, please consider creating a new email account just for use in communicating about this complaint.

If the Colonial School District has no way to contact you, it may limit or prohibit the District from taking necessary or requested steps to address the basis of the complaint, and the complaint may be dismissed.

Email Addressrequired

Relationship to the School

Student

Parent/Guardian

District Employee

Other

NOTE: If you are an employee of the Colonial School District or otherwise identified as a mandatory reporter of child abuse (pursuant to Chapter 23 PA.C.S. §6311), please be reminded that the nature of this report may require you to also make a report to ChildLine 1-800-932-0313.

School District Administrator, Compliance Officer and/or Title IX Coordinator, please be advised that the nature of this report may require you to notify law enforcement.

Name of School

Plymouth Whitemarsh High School

Central Montco Technical High School

Colonial Middle School

Colonial Elementary School (4/5 School)

Whitemarsh Elementary School

Ridge Park Elementary School

Plymouth Elementary School

Conshohocken Elementary School

Please describe the basis of the complaint.

Please identify the complainant (if known and if someone other than the complainant is completing this report).

Complainant's Relationship to the School

Student

Parent/Guardian

District Employee

Other

Please describe the relationship of the complainant to the school in more detail. (For example: If a student, please include grade level. If an employee, please include job title. )

Please identify the alleged perpetrator, if known.

Please describe the relationship of the alleged perpetrator to the school, if known. (For example: If a student, please include grade level. If an employee, please include job title. )

Instead of submitting this form, you may deliver or email this complaint to the Title IX Coordinator:

Melissa Figueroa-Douglas
Administrative Offices
230 Flourtown Road
Plymouth Meeting, PA. 19462
Email: moreilly@colonialsd.org