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Dodge City Public Schools

USD 443 - DODGE CITY COMPLAINT FORM - LINK TO GAAA, GAAB, GAAC, GAACA, JCE, JGEC & KN

USD 443 - Dodge City Complaint Form

The policies of Board of Education of U.S.D. No. 443 prohibit discrimination on the basis of race, color, national origin, disability, religion, genetic information, and sex in all programs and activities of the district. Additionally, discrimination on the basis of age is prohibited in employment. Harassment of individuals on any of these grounds is strictly prohibited. Individuals who believe they have been discriminated against on any of these grounds may file a complaint with the Title IX Coordinator:


Tara Schraeder, Executive Director of Human Resources
Address: 2112 First Avenue, Dodge City, KS 67801

Phone: (620) 371-1004

Email address: schraeder.tara@usd443.org

USD 443 - Dodge City Complaint Form English - Printable Version

USD 443 - Dodge City Complaint Form Spanish - Printable Version

Name of Complainant: __________________________________________________________________________________________

Address: ___________________________________________________________________________________________

Email Address: ___________________________________________________________________________________________

Telephone Number: ___________________________________________________________________________________________

Nature of the Complaint (Please Select Any that Apply):

  • I believe that I have or someone I know has been subjected to discrimination on the basis of:
    • Race
    • Color
    • National Origin
    • Racial Harassment
    • Sex
    • Sexual Harassment
    • Disability
    • Religion
    • Age
    • Genetic
    • Harassment on the basis of _____________________;
    • OR
    • General Complaint/Not Related to Perceived Discrimination

My complaint is not one of perceived discrimination or harassment but is regarding the situation described below.

Please describe the incident or act complained of:
Please include information about:

  • Who was the person engaging in the conduct?
  • Who was the conduct directed toward?
  • What was the nature of the conduct?
  • When did it occur?
  • Where did it occur?
  • What effect did the incident have on you?
  • What effect did it have on the person allegedly targeted?

Were there any witnesses to this incident?

  • Yes
  • No

If yes, please indicate who the witnesses were:
___________________________________________________________________________________________
___________________________________________________________________________________________

What action do you believe the school or district should take with regard to this incident?

________________________________________________________________________________________________________________

If this matter proceeds to an investigation or hearing, will you appear and be interviewed and/or testify as to your knowledge of the matter?

  • Yes
  • No