4118.112 and 4218.112 FORM 1 Sexual Discrimination/Harassment
4118.112/4218.112
Form 1
Litchfield Public Schools
35 Wamogo Road ~ Litchfield, Connecticut ~ 06759
SEXUAL DISCRIMINATION / HARASSMENT COMPLAINT
LITCHFIELD PUBLIC SCHOOLS (Personnel)
Name of the complainant
Date of the complaint Date(s) of alleged harassment
Name or names of the alleged harasser(s)
Location(s) where alleged harassment occurred
Name(s) of any witness(es) to the alleged harassment
Detailed statement of the circumstances constituting the alleged discrimination or harassment
Remedy Requested
Litchfield Board of Education
Form Developed: 1/22/2019
Form Revised: 1/14/2021