What to Do When Your Child is Bullied or Harassed : simplebooklet.com

PHILADELPHIA 1315 Walnut Street, 4th Floor Philadelphia, PA 19107 215-238-6970 PITTSBURGH 429 Fourth Avenue, Suite 702 Pittsburgh, PA 15219 412-258-2120 Published July 2019 Rev. 09.2019 Part or all of this publication may be reproduced if credited to Education Law Center. This publication may be downloaded at www.elc-pa.org. ELC’s publications provide a general statement of the law. However, each situation is different. If questions remain about how the law applies to a particular situation, contact ELC’s Helpline for information and advice, or contact an attorney of your choice. @edlawcenterpa facebook.com/educationlawcenter WWW.ELC -PA.ORG ACKNOWLEDGMENTS This guide was prepared by Education Law Center, with principal author Lizzy Wingfield, Esq., Stoneleigh Emerging Leader Fellow 2017–2019, and staff attorney Kristina Moon. This publication was made possible by the generous support of the Stoneleigh Foundation. The Stoneleigh Foundation was founded in 2006 by John and Chara Haas to improve the life outcomes of Philadelphia's most underserved youth. They meet this mission by awarding Fellowships to exceptional leaders who advance change in the systems that serve these young people. ELC would also like to thank all of the young people, youth-serving professionals and organizations, and intake callers who told us that parents in Pennsylvania need more tools to address bullying and harassment. Design by Untuck ABOUT ELC Education Law Center-PA (ELC) is a nonprofit, legal advocacy organization with offices in Philadelphia and Pittsburgh dedicated to ensuring access to a quality public education for all children in Pennsylvania. Through legal representation, impact litigation, policy advocacy, and community engagement, ELC advances the rights of underserved children, including children living in poverty, children of color, children with disabilities, English learners, children in the foster care and juvenile justice systems, LGBTQ youth, and children experiencing homelessness.

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TABLE OF CONTENTS Introduction and Quick Reference to Advocacy Tips .........................................4 How Do I Know if My Child’s Experience Qualifies as Bullying or Harassment? ..................................................................................6 • Differences Between Bullying and Harassment ...................................................6 • What is a Protected Class? ..................................................................................6 HARASSMENT What Can I Do if My Child is Being Harassed? ...................................................8 • Harassment of Students with Disabilities .............................................................9 • Harassment on the Basis of Other Protected Classes (race, national origin, sex, gender identity, sexual orientation, religion) ......................................11 · Philadelphia ....................................................................................................11 · Other Pennsylvania School Districts ...............................................................14 BULLYING What Can I Do if My Child is Being Bullied? ........................................................17 · Philadelphia .....................................................................................................18 · Other Pennsylvania School Districts ...............................................................19 APPENDICES Advocacy Tools and Sample Documents A. Model Safety Plan B. Safety Plan Options: Items to consider adding to a safety plan C. Template for Keeping Records of Bullying/Harassment Incidents D. Sample Letter: Requesting a team meeting to address bullying E. Sample Letter: Requesting child be evaluated for special education F. Sample Letter: Requesting child be re-evaluated because not making progress in special education G. List of organizations that could help advocate in the special education process H. Sample Letter: Requesting an investigation I. Template for Appealing a School’s Decision after Bullying/Harassment Investigation (Copy of the School District of Philadelphia’s form & letter for other districts) J. Guidance for Testimony to a School Board K. Philadelphia Commission on Human Relations Intake Form L. Pennsylvania Human Relations Commission Discrimination Questionnaire M. U.S. Department of Education Office of Civil Rights Complaint Form

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 4 INTRODUCTION Bullying and harassment are pervasive problems in Pennsylvania, the United States, and even globally.1 Students who are bullied are at increased risk of experiencing health problems, academic struggles, and more frequently drop out of school.2 If the school knows that a current student is being bullied or harassed by another student at school, on school grounds, in school vehicles, at a designated bus stop or at any activity sponsored, supervised or sanctioned by the school, the school has a legal duty to investigate and take action to keep your child safe. The school should also provide your child supports and interventions when bullying or harassment occurs outside of school (including on social media) if it is substantially interfering with your child’s education or causing a threatening environment. This guide offers suggested steps to ensure the school fulfills these duties. The Guide is organized by geographic areas, because the legal options to complain about harassment can vary depending on where you live. So for example, you can turn directly to the pages that cover Philadelphia if your child attends a School District of Philadelphia or charter school in Philadelphia. WHAT THIS GUIDE COVERS This guide describes the rights of students and legal duties of public schools in Pennsylvania, including charter schools. It does not cover students who are in a private school and are placed there by a guardian. If your child has a disability and was placed at a private school through a public school, your child has additional rights and you should call Education Law Center for advice at 215-238-6970.

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 5 QUICK REFERENCE: BASIC ADVOCACY TIPS The most important thing is to report bullying promptly and take good notes regarding bullying incidents and communications with your school. You can keep records for yourself in a notebook, on your phone, or on your computer. Your notes should include: dates when your child is bullied or harassed who the students targeting your child are (if possible, keep records of names and grades) what the other students say or do to your child (include any pictures of physical injury caused by the bullies, as well as any medical records) where the bullying happened who saw the bullying who your child told about the bullying when you report the bullying and who you report it to, and what they say. • Always keep copies of any letters, reports, or other materials you receive or give to school officials. You can create a separate folder in your email to save messages to and from the school staff. You can also take a picture of hard-copy documents and email them to yourself to save them in your email-folder. • Would your child benefit from emotional or mental health support? If your child is feeling down, sad, anxious, is fearful of going to school, is having thoughts of hurting herself or death by suicide, or is having other mental health struggles, you should consider arranging for counseling or therapy for your child. You should also keep records of your child’s counseling or therapy visits to show how the bullying or harassment has affected your child. If your child is diagnosed with a mental health condition, you can ask for a special education plan or 504 Plan to address the bullying or harassment. Directions for how to ask for a special education plan are on page 9, and you can find factsheets about 504 Plans on ELC’s website. • School Meetings · Before you go to a school meeting, write up a list of issues you would like to discuss and determine what you want the school to do. Appendix B has a list of possible actions you could ask the school to take. · When you attend school meetings, ask each person at the meeting to tell you their name and position—and keep notes. · Make sure to ask questions if you don’t understand something. · Don’t sign anything that you don’t understand. You can always take papers home to read before you sign them. · If you do not receive anything in writing at the meeting, send an email or a letter afterwards that gives a summary of everything you talked about and everything that the school agreed to. Follow-up with school officials. If a school official has agreed to do something, make sure it gets done. Be persistent and respectful.

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 6 HOW DO I KNOW IF MY CHILD’S EXPERIENCE QUALIFIES AS BULLYING OR HARASSMENT? The Difference Between Bullying and Harassment BULLYING In Pennsylvania, your child meets the legal definition of being bullied if all of the following boxes can be checked: Another student or group of students did something or said something highly offensive to your child; The other student did what they did to your child on purpose (“intentional” act); The other student’s action(s) took place in school, on school property, at a bus stop, or at a school event; The other student’s actions targeting your child are: severe, something that many students do to your child or that happens often to students in your child’s school, and/or something that the student did to your child repeatedly; and What the other student or students did is so significant that it makes a big difference in your child’s education, creates a threatening environment for your child, or keeps the school from running normally.3 The key difference between bullying and harassment is why other students are targeting your child. HARASSMENT If other students are targeting your child because s/he is a member of a “protected class” (defined below), then your child may be experiencing harassment. Sometimes the insults or language a student uses can signal that they are targeting your child because of traits of a protected class. What is a Protected Class? A protected class is a group of people for whom our civil rights laws provide protections because they have been historically discriminated against and treated unfairly. The legal options to complain about harassment can vary depending on where you live, so this Guide is divided into geographic regions when needed to describe which classes are protected in different areas. Under Pennsylvania and federal laws, schools must try to stop the harassment if your child is being targeted because of one or more of the following protected classes: • Ancestry;4 • Color;5 • Disability;6 • National Origin;7 including immigration status and limited English proficiency • Race;8 • Religion;9 • Sex, which includes: · Gender, · Gender Identity, · Gender Expression, · Sexual Orientation,10 · Sexual Harassment (including unwelcome conduct of a sexual nature, including sexual advances, talking about or requesting sex acts, unwanted sexual contact, and sexual violence including rape)11 • Use of a Support Animal12 In Philadelphia, in addition to the groups of people listed for Pennsylvania and federal protections, schools must try to stop the harassment if students are targeted because of one of the following protected classes: • Breastfeeding parent, • Survivor of sexual violence, • Familial status (meaning discrimination against a student because they care for a family member) or • Marital status (meaning discrimination because a student is not married, married, separated, divorced, or widowed).13

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 7 In Pittsburgh and Allegheny County, in addition to the groups listed for Pennsylvania and federal protections, students may be in a protected class because of: • Family status (including discrimination because the student is pregnant, trying to get custody of someone under the age of 18, or because of the guardian the student lives with), or • Marital status.14 Other geographic areas. If you live outside of Philadelphia and Allegheny County, you should check your local city or county antidiscrimination law (called an “ordinance”) to see what it lists as a protected class. School district protected classes. School districts are required to publicly post their anti-harassment policies. You should look up the anti-harassment policy of your school district’s website or in the Code of Conduct to review which protected classes the school district identifies, because your district may include more protected classes than what is listed above. For example, in addition to the above classes, the School District of Philadelphia also lists English language proficiency, socioeconomic status, and political beliefs as protected classes.15 The actions and statements targeting your child may reference a protected class. For example, if your child has an intellectual or learning disability, and bullies call your child “dumb,” “stupid,” or a slur related to her disability, that could be a sign your child is being harassed because of her disability. If your child is a boy and is called anti-gay slurs, “sissy,” or is compared to girls in a derogatory way, that is a sign your child is being harassed because of what the bullies think about his gender or sexual orientation. Racial slurs are also signs of harassment. Sexual harassment can include “unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature.”16 Sexual harassment falls under the “sex” protected class, no matter your child’s gender or the gender of the students who are targeting them. Common signs of sexual harassment include if another student makes sexual advances toward your child in a way that makes her uncomfortable or tries to touch your child in a way that is inappropriate. It is also a sign of sexual harassment if students are targeting your child with comments suggesting she is sexually active, including “slut,” “whore,” “call Lea for a good time.” In some cases, children are harassed because of multiple protected classes, such as race and gender. No matter if the harassment is on the basis of one class or several, schools are required under law to treat harassment especially seriously.

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 9 If your child has a disability and is bullied or harassed, the harassment must be addressed in their IEP or 504 plan. Students with disabilities have the right to free appropriate public education (“FAPE”), and harassment or bullying that interferes with the child’s ability to attend school or focus and make progress in school may be a legal denial of the child’s special education rights. You may be entitled to compensatory education (money or services to help your child catch up in school) if the school did not try and stop the bullying when they should have. Read ELC’s special education guide for more information. 1. KEEP DETAILED RECORDS As with all instances of bullying and harassment, you should make sure to keep detailed records. You can keep records for yourself in a notebook, on your phone, or on your computer. Your notes should include: dates when your child is harassed who the students targeting your child are (if possible, keep records of names and grades) what the other students say or do to your child (include any pictures of physical injury caused by the bullies, as well as any medical records) where the harassment happened who saw the harassment who your child told about the harassment when you report the harassment and who you report it to your child’s ideas on what would help make school better for them, to share with the school. 2. ASK THE SCHOOL TO TAKE ACTION If your child already has an IEP or 504 plan, you should state in any complaint form that your child is a student with disabilities and request an “emergency” team meeting—in writing—to address the bullying or harassment. In your description, describe the specifics and reasons for your child’s harassment. To request a team meeting, you should send an email or letter to your principal and director of special education. Make sure to keep a copy of your letter. A sample letter or email may be found in Appendix D. If your child does not have an IEP or 504 plan but you think that they need one, you can request for your child to be evaluated and that the harassment be addressed as part of the evaluation. To request an evaluation, you should send an email or letter to your principal and director of special education. You should also reference your request for an evaluation in any bullying complaint form. Make sure to keep copies of your letter. A sample letter may be found in Appendix E. If your child has been struggling to report the bullying, you may request that the IEP team create a goal for developing self-advocacy skills. If your child is in immediate danger at school, your letter should state that and should ask that the evaluation be completed on an expedited (faster) timeline. While you wait for the evaluation, you can also ask for an interim plan to keep your child safe (or “safety plan”). See Appendix B for tips about safety plans. ELC’s special education guide provides more detail about the evaluation process. ADVOCACY STEPS Bullying or Harassment of Students with Disabilities ALL PENNSYLVANIA SCHOOL DISTRICTS

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 10 3. PARTICIPATE IN THE EVALUATION OR TEAM MEETING Before the evaluation or team meeting, it may be helpful to have a doctor or psychologist evaluate your child. If your child has developed anxiety or other mental distress since she has been targeted, you should get a letter from your doctor noting those diagnoses and any recommendations for how the school can help. You should also seek your doctor’s opinion about what other disabilities your child may have and what your doctor thinks the school should do to address your child’s needs. If you bring a letter or note from your doctor to the evaluation and the team meetings, the school will consider that information in the special education plan. You should also think about what specific help for harassment may be useful for your child. See Appendix A and B for a sample plan to keep your child safe (or “safety plan”) and a list of things you can ask your school to do to address the harassment. You are allowed to bring an advocate with you to meetings with the school. You may also want an advocate with you at team meetings or when the school informs you of the results of the evaluation. Appendix G lists advocacy organizations that may be able to send someone to attend those meetings. You can also hire a private attorney. If you do not agree with the outcome of the evaluation or team meeting, review Chapter 12 of ELC’s special education guide for a list of next steps. ALL PENNSYLVANIA S CH OOL DI S T RI CT S Bullying or Harassment of Students with Disabilities

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 11 1. KEEP DETAILED RECORDS As with all instances of bullying and harassment, you should make sure to keep detailed records. You may keep records for yourself in a notebook, on your phone, or on your computer. Your notes should include: dates when your child is harassed who the students targeting your child are (if possible, keep records of names and grades) what the other students say or do to your child (include any pictures of physical injury caused by the bullies, as well as any medical records) where the harassment happened who saw the harassment who your child told about the harassment when you report the harassment and who you report it to your child’s ideas on what would help make school better for them, to share with the school. 2. ASK THE SCHOOL TO TAKE ACTION In the School District of Philadelphia, you can ask for a harassment investigation to be completed – by letter or email to the principal and/or notifying the school district by filling out an online complaint. If you do not have access to the internet, you can notify the district by calling 215-400-4000. In a Philadelphia charter school, you should follow the instructions in the school’s handbook or website for making a complaint about bullying or harassment. If the charter’s policy is not clear, you should write a letter or email to the principal. ELC recommends sending a written complaint every time your child is harassed in school. If you are filling out an online form, you should keep a copy (print or take a photo of the screen) in case the online form does not send you a copy by email. If you called with a complaint, make a note of the date you called and who you spoke to. If you are worried about your child’s safety while the school investigates the harassment, you should email or write a letter to your principal asking for an emergency meeting to create a plan to ensure your child’s safety (or “safety plan”) until the investigation is completed. See Appendix B for a list of suggestions of measures that could go in a safety plan. 3. FOLLOW UP If your child continues to be harassed, you should submit another bullying/harassment form each day your child is harassed. Submitting a form every time this happens is important because it will show what the school did and did not do for your child. This record also may be helpful in the event that you choose to seek legal help. School District of Philadelphia The School District of Philadelphia policy suggests that you should get a response to your request for an investigation within 7 school days unless your school has informed you it needs additional time.17 If you have not heard back from your school or the district within 7 days, you should contact the Office of Climate and Safety at the School District of Philadelphia by calling 215-400-4000. You can ADVOCACY STEPS Harassment Harassment may be based on race/color, national origin, sex/gender, gender identity and gender expression, sexual orientation, relation and all others listed on page 6-7. PHILADELPHIA

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 12 also send your principal a letter or an email asking for an update on the harassment investigation. You should keep a copy of the letter or email. If you do not receive a response within 14 school days, consider moving on to other forms of advocacy. If you received a response from your school or the district about your harassment complaint, but you are unhappy that they either 1) did not find that your child was harassed or 2) found that your child was harassed but are not addressing the harassment appropriately, you should first meet with your principal to share your concerns. If the meeting with the principal does not resolve your concerns, you can file an appeal within 15 calendar days of getting the results of the investigation.18 You can appeal the results of the investigation by submitting an appeal (see a template of an appeal letter in Appendix I) and sending it to the District’s Title IX coordinator (address below). The Coordinator should respond to your appeal within 15 days.19 If the Coordinator does not respond, or the response does not resolve the issue, consider moving on to other advocacy options. Philadelphia Charter Schools Each charter school may have its own policy for appealing the investigation and finding of a harassment complaint. Follow the instructions in your charter school’s policy. If the policy is not clear, write a letter to the Executive Director or Board of Directors of your charter school. 4. TESTIFY BEFORE THE SCHOOL BOARD If the school or district is not helpful in stopping the harassment of your child, you can speak to the school board to inform them of your child’s experience and ask them to step in. For a school in the School District of Philadelphia: You can register to speak at an Action Meeting or a Student Achievement and Support Committee Meeting. You can register to speak at an Action Meeting by filling out an online form or calling 215-400-5959. You can register to speak at a Student Achievement and Support Committee Meeting by filling out a form or calling 215-400-4010. You should plan to speak for three minutes or less at the meeting. You should also bring a copy of what you are planning to say to the board. For guidance about how you could prepare remarks to the board, see Appendix J. For a Philadelphia charter school: Meetings of the board of directors for the charter school should be publicly posted on the school’s website. You can also ask the school staff when the board meets and how you can sign up to speak at the board meeting. If you cannot find information about speaking at a board meeting for your charter school, call the School District of Philadelphia’s Charter School Office and ask them for help. You can contact the Charter School Office by emailing charters@philasd.org, calling 215-400-4090, or going in person to 440 North Broad Street, first floor, suite 102. You do not have to wait to testify to the school board before filing a complaint with an outside agency (see step below). You can plan to talk to the school board at the same time you are filing a complaint with an outside agency or file a complaint without ever testifying before the school board. However, ELC recommends testifying before the school board first because a school board can move faster to address your concerns than an outside agency. 5. FILE A COMPLAINT WITH AN OUTSIDE AGENCY As with all school districts in Pennsylvania, you have the option of submitting a complaint regarding harassment to the state civil rights agency, the Pennsylvania Human Relations Commission (PHRC), and/or to the U.S. Department of Education’s Office of Civil Rights (OCR). Directions for how to file a complaint with the PHRC are on page 15 and directions for how to file a complaint with OCR are on page 16. In Philadelphia, you can also submit a complaint to the Philadelphia Commission on Human Relations (PCHR). You are allowed to submit a complaint to any or all of these agencies at the same time. However, it is possible that only one agency will investigate your complaint. Chief Student Support Services Officer Title IX Co-Coordinator, Karyn Lynch 440 N. Broad Street, Philadelphia, PA 19130 PHILADELPHIA Harassment

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 13 Filing a Complaint with the Philadelphia Commission on Human Relations • Types of Harassment Cases You Can Take to the PCHR · You can file a complaint with the Philadelphia Commission on Human Relations if your child was discriminated against because of their ancestry, color, disability, status as a survivor of domestic or sexual violence, ethnicity, familial status, gender identity, marital status, national origin, race, religion, sex, or sexual orientation.20 Sex discrimination includes discrimination involving discrimination based on pregnancy or childbirth.21 • How to Ask the PCHR to Investigate · PCHR can investigate your child’s harassment if students have targeted your child within the last 300 days. You can ask the PCHR to investigate your child’s harassment by filling out an intake form, which can be found in Appendix K. Public schools are considered “public accommodations,” so you should fill out the public accommodations form. · After you fill out the form, you should fax, mail, or bring it in person to the PCHR (see address below). After they have received your form, they will schedule a meeting with you to discuss if they can help you. Philadelphia Commission on Human Relations 601 Walnut Street, Suite 300 South Philadelphia, PA 19106 Phone: 215-686-4670 Fax: 215-686-4684 PHILADELPHIA Harassment

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 14 1. KEEP DETAILED RECORDS As with all instances of bullying and harassment, you should make sure to keep detailed records. You can keep records for yourself in a notebook, on your phone, or on your computer. Your notes should include: dates when your child is harassed who the students targeting your child are (if possible, keep records of names and grades) what the other students say or do to your child (include any pictures of physical injury caused by the bullies, as well as any medical records) where the harassment happened who saw the harassment who your child told about the harassment when you report the harassment and who you report it to your child’s ideas on what would help make school better for them, to share with the school. 2. ASK THE SCHOOL TO TAKE ACTION You should find your school district’s bullying and harassment policy. The policy should be located on your school’s website, either in its own section or in the district’s Code of Conduct. If you cannot find it online, you should be able to call your school and request a copy. In that policy, it will list a staff member who is in charge of bullying and harassment issues. Once you know the staff person who is supposed to be in charge of harassment issues, you should send an email or letter requesting an investigation to that person, your principal, and your superintendent. If you cannot find the person who is supposed to be in charge of harassment issues, you can send the email or letter to the principal. Make sure to save a copy of whatever you send. In the email or letter, you should describe the harassment and explain that you think your child is being harassed because of their protected class(es). You can use our sample letter in Appendix H. If you are worried about your child’s safety while the school investigates the harassment, you should include in your email or letter to your principal a request for an emergency meeting to create a plan to ensure your child’s safety (or “safety plan”) until the investigation is completed. See Appendix A and B for a sample safety plan and list of suggestions of measures that could go in a safety plan. Charter Schools You should follow the instructions in the school’s handbook or website for making a complaint about bullying or harassment. If the policy is not clear, you should write a letter or email to the principal. 3. FOLLOW UP Your school’s harassment policy should describe how long it will take your school to investigate. If your school does not complete an investigation within that time frame, you should write an email or letter to your superintendent and your school board. Keep a copy of whatever you send. If the school still does not complete an investigation, consider moving on to other advocacy options. If your school completed an investigation into the ADVOCACY STEPS Harassment Harassment may be based on race/color, national origin, sex/gender, gender identity and gender expression, sexual orientation, relation and all others listed on page 6-7. OTHER PENNSYLVANIA SCHOOL DISTRICTS

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 15 harassment and either did not find that your child was harassed or did not take appropriate steps to make sure your student will not be harassed again, you can follow your school district’s appeal process if they have one. The appeal process may be explained in the bullying or harassment policy, though it could also be listed in a separate appeal policy. Charter Schools Each charter school may have its own policy for appealing the investigation and finding of a harassment complaint. Follow the instructions in your charter school’s policy. If the policy is not clear, write a letter to the Executive Director or Board of Directors of your charter school. 4. TESTIFY BEFORE THE SCHOOL BOARD If the school or district is not helpful in stopping the harassment, you can speak to the school board to inform them of your child’s experience and ask them to step in. You should register to speak at the board meeting ahead of time. You should confirm the length of time you are allowed to speak as well as how many copies of your statement to bring. See Appendix J for guidance about how to speak to the board. You do not have to wait to testify before the school board before filing a complaint with an outside agency. You can plan to talk to the school board at the same time you are filing a complaint with an outside agency or file a complaint without every testifying before the school board. However, ELC recommends testifying before the school board first because a school board can move faster to address your concerns than an outside agency. 5. FILE A COMPLAINT WITH AN OUTSIDE AGENCY In all school districts in Pennsylvania, you have the option of submitting a complaint regarding harassment to the state civil rights agency, the Pennsylvania Human Relations Commission (PHRC), and/or to the U.S. Department of Education’s Office of Civil Rights (OCR). You can submit a complaint with either or both agencies. You should also look up whether your city or county has its own civil rights agency, or human relations commission. However, it is possible that only one agency will investigate your complaint. Filing a Complaint with the Pennsylvania Human Relations Commission (PHRC) • Types of Harassment Cases You Can Take to the PHRC · You can file a complaint with the PHRC if your child was discriminated against because of their race, color, sex, ancestry, national origin, religion, disability, or the use of guide or support animals for disability.22 You can also file a complaint with the PHRC if your child was sexually harassed or harassed because of their sexual orientation or gender identity.23 Your child must have experienced harassment within the past 180 days for the PHRC to consider your complaint. • How to Ask the PHRC to Investigate · You can file a complaint with the PHRC by first filling out the education discrimination questionnaire, which can be found in Appendix L. You can either mail the questionnaire into your local PHRC office or you can file it in person at your PHRC office. The local offices are listed below. The PHRC offices for Adams, Bedford, Berks, Blair, Bradford, Cambria, Carbon, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, and York counties: Non-Disability Harassment PHRC Harrisburg Regional Office 333 Market Street, 8th Floor Harrisburg, PA 17101-2210 717-787-9780 717-787-7279 TTY users only Harassment OTHER PENNSYLVANIA SCHOOL DISTRICTS

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 16 The PHRC offices for Bucks, Chester, Delaware, Montgomery, and Philadelphia counties: The PHRC offices for Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, and Westmoreland counties: Filing a Complaint with the Federal Government through the Office of Civil Rights • Types of Harassment Cases You Can Take to the OCR · You can file a complaint with the U.S. Department of Education’s Office of Civil Rights if your child was discriminated against because of their race, color, national origin, ethnicity, or ancestry.24 This includes if your child is harassed because they are an English learner or because your child is Hindu, Jewish, Muslim, or Sikh.25 You may also file a complaint if your child was harassed because of their sex.26 Sex-based harassment includes harassment because of your child’s sexual orientation, because they do not act like a stereotypical boy or girl, or because they are or are not pregnant or a parent.27 · While the OCR used to take cases relating to harassment because a child is transgender, under the Trump Administration, the OCR has stopped investigating many of those claims.28 If your child is being harassed because they are transgender, nonbinary, or gender-nonconforming, you may submit a complaint to the OCR, but you should also submit a complaint to the PHRC and/or your local human relations agency if your local ordinance protects transgender people. • How to Ask the OCR to Investigate · You can ask the OCR to investigate if your child was harassed and the school failed to respond within the last 180 days. You can submit a complaint form online or by mail (a copy is in Appendix M). If OCR needs information from you, they will contact you.29 Make sure to respond to any requests from OCR within 14 calendar days. More information on the process can be found on the OCR’s website. PHRC Philadelphia Regional Office 110 North 8th Street, Suite 501 Philadelphia, PA 19107 215-560-2496 215-560-3599 TTY users only PHRC Pittsburgh Regional Office 301 Fifth Avenue Suite 390, Piatt Place Pittsburgh, PA 15222 412-565-5395 412-565-5711 TTY users only Harassment OTHER PENNSYLVANIA SCHOOL DISTRICTS

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 17 What Can I Do if My Child is Bullied? If your child’s experiences include all of the factors below but your child is not being targeted because of a protected class (listed on page 6–7), then your child may be experiencing bullying, not harassment. In Pennsylvania, your child meets the legal definition of being bullied if all of the following boxes can be checked: Another student or group of students did something or said something highly offensive to your child; The other student did what they did to your child on purpose (“intentional” act); The other student’s action(s) took place in school, on school property, at a bus stop, or at a school event; The other student’s actions targeting your child are: severe, something that many students do to your child or that happens often to students in your child’s school, and/or something that the student did to your child repeatedly; and What the other student or students did is so significant that it makes a big difference in your child’s education, creates a threatening environment for your child, or keeps the school from running normally.30 We recommend that you follow these advocacy steps to collect clear records of the incidents and harm caused to your child, and always make your requests for help in writing when asking your school to address the bullying.

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 18 1. KEEP DETAILED RECORDS As with all instances of bullying and harassment, you should make sure to keep detailed records. You can keep records for yourself in a notebook, on your phone, or on your computer. Your notes should include: dates when your child is bullied who the students targeting your child are (if possible, keep records of names and grades) what the other students say or do to your child (include any pictures of physical injury caused by the bullies, as well as any medical records) where the bullying happened who saw the bullying who your child told about the bullying when you report the bullying and who you report it to your child’s ideas on what would help make school better for them, to share with the school. 2. ASK THE SCHOOL TO TAKE ACTION In Philadelphia, you can request an investigation into your child’s bullying by writing to the principal and/or notifying the school district by filling out an online form that is submitted to the District. If you do not have access to the internet, you can tell the school district by calling 215-400-4000 to make a report. You should make a complaint—whether through the online form or by email or letter to the principal—every day that your child is bullied in school. If you are filling out the form online, you should keep the copy of the form that is sent to your email. If you called in your complaint, make a note of the date you called and who you spoke to. If you are worried about your child’s safety while the school investigates the bullying, you should email or write a letter to your principal asking for an emergency meeting to create a plan to ensure your child’s safety (or “safety plan”) until the investigation is completed. See Appendix A and B for a model safety plan and a list of suggestions of measures that could go in a safety plan. 3. FOLLOW UP If your child continues to be bullied, you should submit another complaint for each day your child is bullied. You should get a response to your request for an investigation within 7 school days. If you do not hear back from your school or the District within 7 days, you should inform the District by calling 215-400-4000. You should also send your principal a letter or an email asking for an update on the bullying investigation. You should keep a copy of the letter or email. If you do not receive a response within 14 school days, you should consider moving on to other advocacy options. If you received a response from your school or the District about your harassment complaint, but you are unhappy that they either 1) did not find that your child was bullied or 2) found that your child was bullied but are not addressing the bullying appropriately, you should meet with your principal to express your concerns. If a meeting with the principal does not resolve your concerns, you can file an appeal within 15 calendar days of getting the results of the investigation. You can appeal the results of the investigation by filling out the appeal form (see Appendix I) and giving it to the district, either in person or via email. The district should get back to you within 21 school days. Make sure to keep a copy of your appeal. If you do not get a response within 21 days or if you do not like the results of your appeal, you can consider moving on to other advocacy options. 4. TESTIFY BEFORE THE SCHOOL BOARD If the District is not helpful in getting your school to stop your child’s bullying, you can speak to the school board to tell them about your child’s experience. You can register to speak at an Action Meeting or a Student Achievement and Support Committee Meeting. You can register to speak at an Action Meeting by filling out an online form or calling 215-400-5959. You can register to speak at a Student Achievement and Support Committee Meeting by filling out a form or calling 215-400-4010. You should plan to speak for 3 minutes or less at the meeting. You should also bring a copy of what you are planning to say to the board. For guidance about how you could prepare remarks to give to the board, see Appendix J. ADVOCACY STEPS Bullying PHILADELPHIA

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What To Do When Your Child is Bullied or Harassed: A Parent’s Guide to Advocacy in Pennsylvania Public Schools Education Law Center www.elc-pa.org 19 1. KEEP DETAILED RECORDS As with all instances of bullying and harassment, you should make sure to keep detailed records. You can keep records for yourself in a notebook, on your phone, or on your computer. Your notes should include: dates when your child is bullied who the students targeting your child are (if possible, keep records of names and grades) what the other students say or do to your child (include any pictures of physical injury caused by the bullies, as well as any medical records) where the bullying happened who saw the bullying who your child told about the bullying when you report the bullying and who you report it to your child’s ideas on what would help make school better for them, to share with the school. 2. ASK THE SCHOOL TO TAKE ACTION You should read your school district’s bullying and harassment policy. That policy should be on your school’s website, either in its own section or in the district’s Code of Conduct. If you cannot find it online, you should be able to call your school and request a copy. The policy will list a staff member who is in charge of bullying and harassment issues. Once you identify the staff person who is supposed to be in charge of bullying issues, you should send that person, your principal, and your superintendent an email or letter requesting an investigation. If you cannot find the person who is supposed to be in charge of bullying issues, you can send the email or letter to the principal and superintendent. Make sure to save a copy of whatever you send. In the email or letter, you should describe the bullying, including who your child is being bullied by and what the other students have done or said to your child. You can use our sample letter in Appendix H. If you are worried about your child’s safety while the school investigates the bullying, you should include in your email or letter to your principal a request for an emergency meeting to create a plan to ensure your student’s safety (or “safety plan”) until the investigation is completed. See Appendix A and B for a sample safety plan and a list of suggestions of measures that could go in a safety plan. Charter Schools You should follow the instructions in the school’s handbook or website for making a complaint about bullying or harassment. If the policy is not clear, you should write a letter or email to the principal. 3. FOLLOW UP Your school’s bullying and harassment policy should say how long the school can take to investigate. If your school does not complete an investigation in that timeline, you should notify your superintendent and your school board. You should either email or send a letter to the superintendent and the school board and keep a copy of whatever you send. If the school still does not complete an investigation, consider moving on to other advocacy options. If your school completed an investigation into the bullying and either 1) did not find that your child was bullied or 2) did not take appropriate steps to make sure your student will not be bullied again, you can follow your school district’s appeal process if they have one. If they do not have an appeal process or if the appeal process is not helpful to you, consider moving on to other advocacy options. Charter Schools Each charter school may have its own policy for appealing the investigation and finding of a bullying complaint. Follow the instructions in your charter school’s policy. If the policy is not clear, write a letter to the Executive Director or Board of Directors of your charter school. ADVOCACY STEPS Bullying OTHER PENNSYLVANIA SCHOOL DISTRICTS

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Education Law Center www.elc-pa.org 22 1 See e.g. GLSEN, School Climate in Pennsylvania 1 (2019) (reporting that LGBTQ students experience high rates of harassment in Pennsylvania schools); National Bullying Prevention Center — Bullying Statistics, https://www.pacer.org/bullying/resources/stats.asp (last visited May 11, 2019) (“More than one out of every five (20.8%) students report being bullied.”). 2 See Preventing Bullying through Science, Policy, and Practice 115–29 (Frederick Rivara & Suzanne Le Menestrel eds., 2016) (finding that students who were bullied are more likely to experience depression, anxiety, and feelings of loneliness); Jaana Juvonon, et. al., Bullying Experiences and Compromised Academic Performance Across Middle School Grades, 31 J. OF EARLY ADOLESCENCE 152, 167 (2011) (noting how poor academic performance may manifest for bullied youth). 3 24 Pa. Stat. Ann. § 13-1303.1-A (West) (“For purposes of this article, ‘bullying’ shall mean an intentional electronic, written, verbal or physical act, or a series of acts:(1) directed at another student or students; (2) which occurs in a school setting; (3) that is severe, persistent or pervasive; and (4) that has the effect of doing any of the following: (i) substantially interfering with a student's education; (ii) creating a threatening environment; or (iii) substantially disrupting the orderly operation of the school; and ‘school setting’ shall mean in the school, on school grounds, in school vehicles, at a designated bus stop or at any activity sponsored, supervised or sanctioned by the school.”). Note that under the state law, a school has the ability to define bullying under their school policy as encompassing acts that do not occur in a “school setting.” Id. 4 43 Pa. Stat. Ann. § 955 (West). 5 42 U.S.C.A. § 2000d (West); 43 Pa. Stat. Ann. § 955 (West). 6 42 U.S.C.A. § 12182 (West); 43 Pa. Stat. Ann. § 955 (West). 7 42 U.S.C.A. § 2000d (West); 43 Pa. Stat. Ann. § 955 (West). 8 42 U.S.C.A. § 2000d (West); 43 Pa. Stat. Ann. § 955 (West). 9 U.S. Const. amend. I; 43 Pa. Stat. Ann. § 955 (West). 10 20 U.S.C.A. § 1681 (West); 43 Pa. Stat. Ann. § 955 (West). Gender identity is “[e]xternal manifestations of gender, expressed through a person's name, pronouns, clothing, haircut, behavior, voice, and/or body characteristics.” GLAAD, GLAAD Media Reference Guide —Transgender, http://www.glaad.org/reference/transgender (last visited May 9, 2019).Gender identity is “[a] person's internal, deeply held sense of their gender. For transgender people, their own internal gender identity does not match the sex they were assigned at birth. Most people have a gender identity of man or woman (or boy or girl). For some people, their gender identity does not fit neatly into one of those two choices”. Id. Sexual orientation “[d]escribes a person's enduring physical, romantic, and/or emotional attraction to another person. Gender identity and sexual orientation are not the same. Transgender people may be straight, lesbian, gay, bisexual, or queer. For example, a person who transitions from male to female and is attracted solely to men would typically identify as a straight woman.” Id. 11 See Davis Next Friend LaShonda D. v. Monroe Cty. Bd. of Educ., 526 U.S. 629 (1999). 12 43 Pa. Stat. Ann. § 955 (West). 13 See Philadelphia, PA., Code § 9-1106 (2016); Phila. Human Relations Commission, Public Accommodations Discrimination, https://www.phila.gov/HumanRelations/DiscriminationAndEnforcement/WhatIsDiscrimination/Pages/PublicAccommodationsDiscrimination.aspx (last visited Apr. 22, 2019) (defining “familial status” and “marital status”). 14 Allegheny Cnty, Pa, Code § 215-35; Pitt. Code § 651.04. 15 The School Dist. of Phila., No. 248, 2 (2018). 16 EEOC, Sexual Harassment, https://www.eeoc.gov/laws/types/sexual_harassment.cfm (last visited June 4, 2019). 17 See The School Dist. of Phila., No. 248, 4 (2018) (“Extenuating circumstances for not being able to comply with the deadline must be approved by the Title IX Deputy Coordinator. The extension must be a specified period of time not exceeding fourteen (14) days, and must be communicated to the complainant.”); The School Dist. of Phila., Bullying & Harassment: Office of Climate & Safety, https://www.philasd.org/bullying/ (last visited Dec. 14, 2018) (stating that, after a complainant fills out the bullying and harassment form, “[w]e promise to be back in touch within 7 school days”). 18 The School Dist. of Phila., No. 248, 5 (2018). 19 Id. at 5. 20 See Pennsylvania Commission on Human Relations, Public Accommodations Discrimination, https://www.phila.gov/HumanRelations/DiscriminationAndEnforcement/WhatIsDiscrimination/Pages/PublicAccommodationsDiscrimination.aspx (last visited Jan. 29, 2019). 21 Id. 22 Pa. Human Relations Comm’n, File a Complaint, https://www.phrc.pa.gov/File-A-Complaint/Pages/About-Filing-A-Complaint.aspx (last visited Feb. 6, 2019). 23 See Pa. Human Relations Comm’n, Guidance on Discrimination on the Basis of Sex under the Pennsylvania Human Relations Act (Aug. 2, 2018). 24 U.S. Department of Education, OCR Complaint Forms – Electronic and PDF Versions, https://www2.ed.gov/about/offices/list/ocr/complaintintro.html (last visited Dec. 15, 2018). 25 Id. 26 Id. 27 Id. 28 See Letter from Candice Jackson, Acting Assistant Secretary of Civil Rights, U.S. Dep’t of Educ. Office of Civil Rights, to Regional Directors, U.S. Dep’t of Educ. Office of Civil Rights (June 6, 2017), https://www.documentcloud.org/documents/3866816-OCR-Instructions-to-the-Field-Re-Transgender.html. 29 Allegheny County Human Relations Commission, Complaints, https://www.alleghenycounty.us/commissions/human-relations/complaints.aspx (last visited Apr. 16, 2019). 30 24 Pa. Stat. Ann. § 13-1303.1-A (West) (“For purposes of this article, ‘bullying’ shall mean an intentional electronic, written, verbal or physical act, or a series of acts:(1) directed at another student or students; (2) which occurs in a school setting; (3) that is severe, persistent or pervasive; and (4) that has the effect of doing any of the following: (i) substantially interfering with a student's education; (ii) creating a threatening environment; or (iii) substantially disrupting the orderly operation of the school; and ‘school setting’ shall mean in the school, on school grounds, in school vehicles, at a designated bus stop or at any activity sponsored, supervised or sanctioned by the school.”). Note that under the state law, a school has the ability to define bullying under their school policy as encompassing acts that do not occur in a “school setting.” Id.

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MODEL SAFETY PLANStudent’s Name: ___________________________________________________________Parent’s Name: ___________________________________________________________Parent’s Contact Information: Phone __________________ Email: ________________ Primary Staff Contact: _____________________________________________________ Classroom/Homeroom Teacher: ____________________________________________ Grade Level: _______ Room Number:__________Plan start date: ___________________________ Proposed End date: _____________________The following safety plan has been developed for the student named above. The sample interventions offered are not intended to be exclusive or all-inclusive. Schools should design a Student Safety Plan that reflects their unique circumstances and resources. This plan does NOT replace an IEP or a Behavior Support Plan. If the student has an IEP, then defer to that plan. Note: Administrative staff should develop this plan with the student experiencing bullying/ harassment, in an effort to empower them and keep them safe. A safety plan needs to be individualized, as every student who has experienced bullying/harassment has unique needs and challenges. A. BACKGROUNDBrief description of the bullying/harassment student has experienced ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How long has the conduct been taking place? _______________________________________________________________________________________________________________________Are there certain locations where the conduct frequently takes place? ______________________ ____________________________________________________________________________________________________________________________________________________________Are there certain times when the conduct frequently takes place? _____________________________________________________________________________________________________________________________________________________________________________________Are there events/factors that frequently the trigger the conduct (i.e.: does the conduct happen after the student answers a question in class or when the student is alone?)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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MODEL SAFETY PLANA. RESPONSIBILITIES AND ROLESStaff ResponsibilitiesThe following teachers will be apprised of this safety plan and will make every effort to implement it successfully: _______________________________________________________________________________________________________________________________________________________________________________________________________________________The following administrators and school personnel will be apprised of this safety plan and will make every effort to implement it successfully: ______________________________________________________________________________________________________________________________________________________Any staff who witness or are made aware of any harassing, intimidating or bullying behavior directed toward the student will intervene immediately and will report such behavior to ______________________________.Parent/Family ResponsibilitiesParents and other family members agree to monitor and support the student with this Safety Plan, monitor the student’s use of technologies, and contact school if the problem persists.The school will immediately report any harassing, intimidating or bullying behavior which it is made aware of to the student ‘s parents.The school will meet with the parents ___________________________________ [date or frequency] to discuss and review this plan.Parents are welcome to contact the school at any time to check on the effectiveness of the plan. Student Responsibilities The student will make reasonable attempts not have face-to-face contact or online contact with the aggressor while this plan is in effect.The student will report any breach of this plan, on or off school grounds, to his/her parents, designated point of contact, or other teacher/staff person immediately.Counselor Responsibilities The school will perform a functional behavior assessment of the student to determine if the student needs additional services to help him/her improve social skills, better engage in conflict resolution, and/or effectively problem solve during emergency situations.

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MODEL SAFETY PLANThe student will meet with the school counselor to discuss ways he/she will react and deal with conflict and emergency situations in the future, including where the student should go, who they should talk to, and what strategies they can employ.B. INTERVENTIONSPoint of Contact and Trusted Peers:Mr./Ms./Mx. _________________ will be designated as the student’s primary point of contact (trusted adult) on staff. The primary point of contact will be responsible for checking in with the student on a _______________ [daily/weekly/biweekly] basis to ensure the safety plan is working. The student in NOT responsible for locating or making contact with the staff member. Conversations should occur in a private location.The student is responsible for checking in with the primary point of contact to ensure the safety plan is working. The student will report to the primary point of contact’s office/classroom at ____________________________________________[time and dates].Mr./Ms./Mx. ______________________ is designated as the student’s backup point of contact. The backup point of contact has all the same responsibilities as the primary point of contact when that person is absent or unavailable. The primary point of contact is responsible for informing the backup point of contact when they are absent.The student can request to meet with the primary point of contact at any time if he/she feels unsafe. If the primary point of contact is not available the student will either be able to meet with the backup point of contact or __________________________________________________________________The school and/or student have identified the following students as trusted peers: ____________________________________________________________.Classroom Times:The student’s schedule will be changed in the following ways (attach new schedule) _________________________________________________________________________________________________________________________________________________________________________________________________________________________________The following teachers will keep the student and his/her aggressor separated in the classroom and during class activities: ______________________________________________________________________________________________________________________________________________________The student will be seated near one or more of their trusted peers in all classes. Teachers will address any bullying, intimidation, harassment and/or retaliation immediately and will report such conduct to ________________________________ as soon as possible.

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MODEL SAFETY PLANPassing Times:The student will be able to transition before/after [circle one] other students or at the front/back [circle one] of the line and will be separated from his/her aggressor. The student will be able to transition between classes with one or more of their trusted peers. The student will take the following route when transitioning between classes: _______________________________________________________________________Mr./Ms./Mx. __________________ is designated as the student’s hallway monitor and will be visible and available during hallway transitions.The student’s locker will be changed to a different location.The student will have special bathroom privileges in order to avoid contact with aggressors in the restrooms. These privileges include:Use of a single stall/staff restroomAbility to visit the restroom with a trusted peerAbility to use the bathroom at certain times of the day Other __________________________________________________________________Lunch and RecessMr./Ms./Mx. ___________________________________ is designated as the student’s lunchmonitor and will be visible and available during lunch.Mr./Ms./Mx. ___________________________________ is designated as the student’s recess monitor and will be visible and available during recess.The student and his/her aggressor separated during lunch and recess.The student will be seated near one or more of their trusted peers during lunch. Bus/TransportationThe bus driver will be instructed to intervene immediately and to report any bus incidents immediately to the school principal.The bus driver will keep the student and his/her aggressor separated on the bus.The student will have an assigned seat on the bus near one or more of their trusted and separate from his/her aggressor.

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MODEL SAFETY PLANThe student’s transportation will be changed in the following ways: ______________________________________________________________________________________________________________________________________________________Student will be dropped off at school at the following entrance and by the following people: ___________________________________________________________________________Student will be picked up at school at the following entrance and by the following people: ___________________________________________________________________________Other Interventions:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________This plan is in place from _____________________________ through __________________, at which time it will be reviewed, revised or continued, if necessary.WE AGREE TO THE SAFETY PLAN AS STATED ABOVE.___________________________________________________ _________________Student Date___________________________________________________ _________________Parent Date___________________________________________________ _________________Principal/Administrator Date___________________________________________________ _________________Teacher(s)/Counselor DateCompleted / Modified / Extended: _____________________________________________________________ (Date & Signatures)

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SAFETY PLAN OPTIONSItems to Consider Adding to a Safety Plan or Special Education Plan to Address Bullying or HarassmentTHINGS THE SCHOOL CAN DOAgree to immediately tell you when your child is bullied or harassed Pick a specific person at the school who will call you regularly to update you about how the safety plan is working. The plan should be specific about:how often the call should happen, at what time, and whether the school should call you or you should call the school. Pick a specific person to check in with your child at the end of every day so that your child has the opportunity to report any bullying or harassment The person should be someone your child feels comfortable with It should be the responsibility of the person to check in with your child, not your child’s responsibility to find them They should meet somewhere privately The school should pick a backup person to check in with your child when the other person is out.Change the location of your child’s locker to be farther away from their bullies or harassersChange your child’s class seat or the seat of the bully Tell all of your child’s teachers and all school staff supervising times when your child and their bully could see each other (such as lunchtime, recess, hallways, school arrival/dismissal) about the safety plan. Remind all teachers, administrators, and staff of their duty to report any bullying or harassment they see.Increase supervision at:School arrival and departure recesslunchgymbathroomslocker roomsOther points where the bully and your child come into contact, including: ____________Change the bully’s schedule or your child’s schedule so that they will not have to be near each other during:School arrival and departure Transportation to and from schoolClassRecessLunchGymAfterschool activities and/or extracurricularsOther points where the bully and your child come into contact, including: _______________

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SAFETY PLAN OPTIONSChange the bully’s or your child’s bus route If that is not possible, the bus driver should be told about the bullying and told to step in if your child is bullied or harassed Give your child access to a bathroom or changing area where they will not have to see their bully, or have the bully use a separate bathroom or changing area Transfer the bully or your child to a different school within the district Assign your child student buddies, who will be with your child when they could come in contact with the bully, such as during lunch, recess, and when my child has to use the bathroom. The student buddies should be students whom your child feels comfortable with and who agree to be your child’s buddy.Assign an adult escort to the bully, who will be with the bully as they walk from class to class. The bully should be told not to leave class until their adult escort is there. Tell the bully not to contact your child in any way — including in person, over social media, or through other students Train staff and teachers how to better respond to bullying or harassment when it happensBring in a cultural competency training for all students so they learn to be more welcoming and accepting of students like my childTHINGS YOUR CHILD CAN DOAgree to go to a specific person during the day if they start to get upset or overwhelmed. The person should be someone your child feels comfortable with.Your child should have permission to leave class if necessary to seek this support. Agree to talk with the counselor or another adult they trust to figure out which students who they feel safe with and serve as student buddies.If your child has trouble reporting when they are bullied or harassed, your child could agree to work on their self-advocacy skills. You should ask if your school has a program that helps students with self-advocacy.If your student has a disability or you think they could have a disability, you can ask for a Functional Behavioral Assessment to help with their ability to report bullying and harassmentTHINGS YOU CAN DO Agree to report any bullying or harassment to the school. If you have had trouble getting in touch with administrators before, you can ask that the school pick a specific person you should report incidents to.

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REQUEST FOR A TEAM MEETING TO ADDRESS BULLYING/HARASSMENTParent/Guardian AddressParent/Guardian Phone NumberDatePrincipal’s NameName of Your Child’s SchoolSchool AddressDear Principal:I am the parent of ___________________________, whose date of birth is ____________.Please schedule an IEP Team Meeting as soon as possible to discuss my child’s needs and IEP services. My child has been suffering in school because of ongoing bullying or harassment that is interfering with their ability to meaningfully progress and participate in school.[Since the bullying began, my child has been diagnosed with mental health problems related to the bullying / started seeing a therapist.]In addition to the people who are required under law to attend the IEP Team Meeting, I would like the following people to be present at this meeting: __________________________________________________________________________________________________________[teachers or other staff aware of bullying/harassment; staff responsible for students when or where incidents have occurred; therapist or other provider working with the student]I will be bringing the following people with me to the meeting: _____________________________________________________________________________________________________When scheduling the meeting, please be aware of my availability: ____________________________________________________________________________________________________[Provide dates or times that you can or cannot meet]Should you have any questions or problems with this request, please contact me at the following number(s) ___________ or by e-mail at _________________________.Thank you.Sincerely,Parent/Guardian Namecc: Director of Special EducationKEEP A COPY OF THIS LETTER FOR YOUR RECORDS. WE RECOMMEND THAT YOU EMAIL OR HAND-DELIVER THIS LETTER TO THE PRINCIPAL AND MAKE SURE SOMEONE SIGNS FOR IT, OR THAT YOU SEND IT BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED. YOU SHOULD ALSO SEND A COPY OF IT TO YOUR SCHOOL DISTRICT’S OR CHARTER SCHOOL’S SPECIAL EDUCATION DIRECTOR.

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REQUEST FOR INITIAL SPECIAL EDUCATION EVALUATIONParent/Guardian AddressParent/Guardian Phone NumberDatePrincipal’s NameName of Your Child’s SchoolSchool AddressDear Principal:I am the parent of ___________________________, whose date of birth is ____________.My child has not been doing well in school and I am therefore requesting a comprehensive evaluation to determine whether my child needs special education services, and, if so, what services are needed. I am particularly concerned that the ongoing bullying my child is experiencing is interfering with their ability to meaningfully progress and participate in school. [Since the bullying began, my child has been diagnosed with mental health problems related to the bullying.]I would like to participate with the school staff to decide what testing is needed and what information about my child should be collected. I'd also like to know when the testing (if any) will be done, and whether any meetings will be scheduled so that I can attend. [As my child has struggled to be able to report the bullying when it occurs, I am requesting that the team consider administering a Functional Behavior Assessment to determine if my child needsassistance with their self-advocacy skills.]I understand that the evaluation must be completed, and a written report given to me, within 60 calendar days (not including the summer months) of the school district’s receipt of the Permission to Evaluate-Consent Form signed by me. [However, because of the severity of the bullying and its impact on my child, I am requesting that you conduct this evaluation on an expedited basis.] Please send me a Permission to Evaluate-Consent Form to sign as soon as possible so that we can begin the process. [Or, I'd like to come to the school and sign the form immediately.]Should you have any questions or problems with this request, please contact me at the following number(s) ___________ or by e-mail at ____________.Thank you.Sincerely,Parent/Guardian Namecc: Director of Special EducationKEEP A COPY OF THIS LETTER FOR YOUR RECORDS. WE RECOMMEND THAT YOU EMAIL OR HAND-DELIVER THIS LETTER TO THE PRINCIPAL AND MAKE SURE SOMEONE SIGNS FOR IT, OR THAT YOU SEND IT BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED. YOU SHOULD ALSO SEND A COPY OF IT TO YOUR SCHOOL DISTRICT’S OR CHARTER SCHOOL’S SPECIAL EDUCATION DIRECTOR.

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REQUEST FOR SPECIAL EDUCATION RE-EVALUATIONParent/Guardian AddressParent/Guardian Phone NumberDatePrincipal’s NameName of Your Child’s SchoolSchool AddressDear Principal:I am the parent of ___________________________, whose date of birth is ____________. I feel that my child is not making progress in his/her special education program. I am particularly concerned that the ongoing bullying my child is experiencing is interfering with their ability to meaningfully progress and participate in school. [Since the bullying began, my child has been diagnosed with mental health problems related to the bullying.] In order to better understand the problem and the type and amount of services that may be needed, I am requesting that my child be reevaluated. [As my child has struggled to be able to report the bullying when it occurs, I am requesting that the team consider administering a Functional Behavior Assessment to determine if my child needs assistance with their self-advocacy skills.]I would like to participate with the rest of the IEP Team in the review to determine what data and testing is needed. I'd also like to know when the testing will be held and whether any meetings will be scheduled so that I can attend.I understand that the reevaluation must be completed, and the written Reevaluation Report given to me, within 60 calendar days (not including the summer months) of your receipt of the Permission to Reevaluate-Consent Form signed by me. [However, because of the severity of the bullying and its impact on my child, I am requesting that you conduct this evaluation on an expedited basis.] Please send me a Permission to Reevaluate-Consent Form to sign as soon as possible so that we can begin the process. [Or, I'd like to come to the school and sign the form immediately.]Should you have any questions or problems with this request, please contact me at the following number(s)____________ or by e-mail at _________________.Thank you.Sincerely,Parent/Guardian NameCc: Director of Special EducationKEEP A COPY OF THIS LETTER FOR YOUR RECORDS. WE RECOMMEND THAT YOU EMAIL OR HAND-DELIVER THIS LETTER TO THE PRINCIPAL AND MAKE SURE SOMEONE SIGNS FOR IT, OR THAT YOU SEND IT BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED. YOU SHOULD ALSO SEND A COPY OF IT TO YOUR SCHOOL DISTRICT’S OR CHARTER SCHOOL’S SPECIAL EDUCATION DIRECTOR.

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ORGANIZATIONS FOR FURTHER ASSISTANCERegion Organization Contact InformationPennsylvania Education Law Center PA www.elc-pa.orgPhiladelphia Office1315 Walnut Street, 4th FloorPhiladelphia, PA 19107215-238-6970Pittsburgh Office429 Fourth Avenue, Suite 702Pittsburgh, PA 15219412-258-2120School District of PhiladelphiaThe Office of Safe Schools Advocate The School District of Philadelphia440 N. Broad Street, Suite 1198Philadelphia, PA 191301-877-730-6315https://www.pccd.pa.gov/ossa/FOR STUDENTS WITH DISABILITIESPennsylvania Disability Rights Pennsylvania (DRP)The Philadelphia Building1315 Walnut St., Suite 500Philadelphia, PA 19107–4798(215) 238-8070 (Philadelphia)(717) 236-8110 (Harrisburg)(412) 391-5225 (Pittsburgh)http://www.drnpa.orgPennsylvania The Parent Education and Advocacy Leadership Center (PEAL) 1119 Penn Avenue Suite 400Pittsburgh, PA 15222P: 412-281-4404 (Pittsburgh)P: 215-567-6143 (Philadelphia)P: 866-950-1040 (Toll Free)https://pealcenter.org/families/Pennsylvania The Arc of Pennsylvania Pennsylvania Place Ste. 403301 Chestnut StreetHarrisburg, PA 17101-2535P: (717) 234-2621info@thearcpa.org;http://www.thearcpa.orgPhiladelphia The Arc of Philadelphia 2350 West Westmoreland StreetPhiladelphia, PA 19140http://arcphiladelphia.orgP: (215) 229-4550Email: contact@arcpddc.org Philadelphia Parents Involved Network (PIN)1211 Chestnut Street, 11th FloorPhiladelphia, PA 19107P: 267-507-3860Toll Free: 800-688-4226ext.: 3860

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LETTER REQUESTING A BULLYING/HARASSMENT INVESTIGATIONParent/Guardian Name: _______________________________________________ Address: _____________________________________________________________City: ________________________ State: ______ Zip Code: __________Phone: _______________________ Email: _______________________ Today’s Date__________________Principal’s Name _____________________________________________Address: ____________________________________________________City: ________________________ State: ______ Zip Code: __________Dear Principal ____________________________,I am the parent of ____________________________________, whose birthdate is __________________My child is being harassed at school. I am therefore requesting an investigation and a prompt response from the school district to ensure that the harassment will stop. The harassment my child has experienced in severe, pervasive, and objectively offensive. The harassment occurred [insert dates or time frame] _________________________________________________________________________________________The harassment took place in [insert where the harassment occurred] __________________________________________________________________________________________________________________The harassment involved [insert detailed description of the harassment, including the name(s) of the perpetrators, the actions they took, and the words they used] __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Witnesses of the harassment include [insert names of anyone who saw your child being harassed] ___________________________________________________________________________________________This harassment has had a negative effect on my child’s education. As a result of this harassment my child has [check all that apply and provide description]been doing worse academically: __________________________________________________________________________________________________________________________________avoided school and/or certain classes: _____________________________________________________________________________________________________________________________

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LETTER REQUESTING A BULLYING/HARASSMENT INVESTIGATIONCheck and fill out the following information if the parent is a non-native English speakerI have limited English proficiency. I am requesting that the District provide translation and interpretation services for all information related to this allegation of bullying. Please provide these services in [insert language] ___________________________________________________experienced psychological symptoms (depression, anxiety, PTSD): ______________________________________________________________________________________________________felt uncomfortable and/or refrained from participating in class or extracurriculars: ________________________________________________________________________________________________________________________________________________________________________withdrawn or considered withdrawing from your school _______________________________________________________________________________________________________________Other: ______________________________________________________________________________________________________________________________________________________The harassment is related to my child’s membership in a protected class, specifically [provide description of which protected classes apply and how you know that is why your child is being targeted]:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I request that the school interview all persons who were involved in or who witnessed the harassment. After the investigation, please intervene with the student(s) responsible in order to ensure that the harassment stops. Should you have any questions about this request, please contact me at [phone number/email] ________________________________________________________________________Sincerely,Parent/Guardian Name* KEEP A COPY OF THIS LETTER FOR YOUR RECORDS. WE RECOMMEND HAND DELIVERING THIS LETTER OR SENDING IT BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED. YOU SHOULD SEND A COPY TO THE SUPERINTENDENT AS WELL.

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PROCEDURES FOR APPEAL PROCESSI. PURPOSE:To provide procedures and general guidelines for the appeal process in the School District of Philadelphia. These processes are applicable for decisions made at both the school level and the central office level.II. RESPONSIBILITY:The Office of Student Rights and Responsibilities is responsible for reviewing and investigating decisions made by school and/or central office staff to determine if the decision was made in accordance with school district policies, procedures, and protocols. III. DECISIONS THAT CAN BE APPEALED:1. Disciplinary transfers- transfers made pursuant to a disciplinary hearing2. Programmatic transfers- transfers for programmatic reasons such as special education, 504 service agreements, or English language learner issues3. Neighborhood school transfers- transfers back to a neighborhood school at the end of a school year for reporting inaccurate residency information to the school, moving out of the neighborhood catchment, or gaining admission to a school without an approved transfer through a district approved process or procedure. (special admission schools only)4. School selection- assignments made after the parent completed the school selection process.We will not reconsider wait list decisions or a disapproval to a school because the applicant does not meet the designated criteria for that school.*English Learners - All student Advocacy Folders for English learners must contain supporting documentation that demonstrates the student can participate successfully given reasonable accommodations. Office of Multilingual Curriculum and Programs will review allof those students who have been disapproved to ensure that the supporting documents have been thoroughly considered by the school regarding the reasonable accommodations the school must provide in order for the student to be successful.5. Homelessness designation-whether a student is homeless)6. Parental exclusion letters- parent is banned from a school building as a result of inappropriate behavior7. Bullying/harassment findings- after the school administrator investigates an allegation of bullying or harassment, the parent disputes the findings of that investigationIV. CRITERIA:In all appeals, the factors that the Student Rights and Responsibilities Staff will consider include, but are not limited to: 1. Whether the parent met with the school administrator at their child's school2. Whether all policies and procedures were followed3. Whether the child's rights were violatedSchool District of Philadelphia.

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4. The health, safety and welfare of the child and the school community. V. PROCESS FOR APPEALS1. Once a parent receives a decision that is made at the school level, the parent MUST first meet with discuss the decision. If a parent disagrees with thedecision, an appeal.The following decisions are made at the school level:1. Homelessness designation2. Parental exclusion letters3. Neighborhood school transfers4. Bullying/Harassment findingsIf a parent disagrees with a central office decision based on the criteria listed above, the central office staff will inform the parent how to file an appeal.The following decisions are made at the central office:1. Programmatic transfers2. School Selection3. Disciplinary Transfers 2. How to file an appealFor all matters listed above, parents must complete the attached form and submit it within 15calendar days of the decision to the Office of Student Rights and Responsibilities either in person at 440 N. Broad Street, Floor 2, and/or by email (parentappeals@philasd.org), along with all relevant documentation received from the school or the central office that made the decision.In all appeals, a staff member in the Office of Student Rights and Responsibilities will review the form and accompanying documentation. If further documentation is required to make a decision, it will be requested from the school or central office that made the decision.Once all of the documents have been received, the staff member will review all materials and make a decision within 21 calendar days. There will be no hearing scheduled and the decision will be made based upon the documentation submitted. The parent and the school will be notified of the decision. The Assistant Superintendent and/or relevant central office departments will also be notified of the decision.VI. RELATED POLICIES118: Code of Student Conduct206: Assignment within the District248: Unlawful Harassment249: Bullying/Cyberbullying251: Homeless StudentsEFFECTIVE DATE: August 27, 2018

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APPEAL OF A DECISION FROM BULLYING/ HARASSMENT INVESTIGATION (OTHER DISTRICTS)Today’s Date__________________Parent/Guardian Name: _______________________________________________ Address: _____________________________________________________________City: ________________________ State: ______ Zip Code: __________ Phone: _______________________ Email: _______________________ Name of Student: _____________________________________________Student date of birth: _____________________Student Current School:________________________Current Grade: ______ Student ID #: __________Dear Compliance Officer:I am the parent of ____________________________________, who receives the following supports in school:504 Service Agreements Individualized Education Plan (IEP) School Therapeutic Services (STS) English Language Learners (ELL)I am appealing the decision of my school’s principal as a result of an investigation into bullying/harassment. As a result of the investigation, the principal decided ____________________________________________________________________________________.I disagree with the principal’s decision because ____________________________________________________________________________________.As a result of this appeal, I would like ____________________________________________________________________________________.Should you have any questions about this request, please contact me at [phone number/email] ____________________________________________________________________________________.I am attaching the following documents that support my appeal: ____________________________________________________________________________________.Sincerely,Parent/Guardian NameKEEP A COPY OF THIS LETTER FOR YOUR RECORDS. WE RECOMMEND THAT YOU EMAIL OR HAND-DELIVER THE APPEAL TO THE COMPLIANCE OFFICER AND MAKE SURE SOMEONE SIGNS FOR IT, OR THAT YOU SEND IT BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED.ATTACH ANY DOCUMENTS INCLUDING MEDICAL RECORDS, TEXTS, EMAILS, SCREENSHOTS, ETC.,THAT SUPPORT YOUR POSITION.

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GUIDANCE FOR TESTIMONY TO THE SCHOOL BOARDGeneral advice:Register to speak before the meeting Ask how long speakers are allowed to speak at meetings and keep your remarks to that length Make sure to describe:o What school your child goes to o How long the bullying or harassment has been going on o How often your child is bullied or harassed o Any names the bullies called your child or things they did to your child that would show the Board how serious this is o How the bullying or harassment has hurt your childo How you tried to get the school to take action o What you would like the Board to help you withIt is not necessary to name the students targeting your child in any public statements. You can tell the Board members privately after your public testimony. Example:My name is John Doe, and my child is a student at Neighborhood Elementary. I am speaking tonight because my child has been terribly bullied since April 10th, and the school administration hasn’t done enough to stop it. The bullying started with another student tripping my son in class, and since then it has only continued and gotten worse. Multiple times a week, my son is called “fat” or “gross” and is hurt by this bully. The bully has even gotten other students to start harming my son, and one of the new bullies pushed my son so hard into his locker that he got a concussion. The bullying has had a terrible impact on my son. He has stopped going to Drama Club because he knows the bullies are there and he is starting to feel bad about himself and believe what the bullies are saying. I have emailed the principal about the bullying more than ten times, and each time she only says she will look into it and talk to the bullies. But that is not doing enough to protect my child, because talking to the bullies hasn’t stopped them and it keeps getting worse. I am speaking tonight in hopes you can make the administration at Neighborhood Elementary finally take my child’s bullying seriously.

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Our Mission is to ensure equal access to education and to promote educational excellence throughout the Nation.United States Department of EducationOffice for Civil RightsDISCRIMINATION COMPLAINT FORM You do not have to use this form to file a complaint with the U.S. Department of Education’s Office for Civil Rights (OCR). You may send OCR a letter or e-mail instead of this form, but the letter or e-mail must include the information in items one through nine and item of this form. If you decide to use this form, please type or print all information and use additional pages if more space is needed. An on-line version of this form, which can be submitted electronically, can be found at: http://www.ed.gov/about/offices/list/ocr/complaintintro.html. Before completing this form please read all information contained in the enclosed packet including: Information About OCR’s Complaint Resolution Procedures, Notice of Uses of Personal Information and the Consent Form. 1. Name of person filing this complaint:Last Name:____________________ First Name:____________________ Middle Name:___________________ Address: _____________________________________________________________________________________________ City:_______________________________________________ State:___ Zip Code:_____________________________ Home Telephone:______________________________ Work Telephone:______________________________ E-mail Address: ____________________________________________________________________________________ 2. Name of person discriminated against (if other than person filing). If the persondiscriminated against is age 18 or older, we will need that person’s signature on thiscomplaint form and the consent/release form before we can proceed with thiscomplaint. If the person is a minor, and you do not have the legal authority to file acomplaint on the student’s behalf, the signature of the child’s parent or legalguardian is required.Last Name:____________________ First Name:____________________ Middle Name:___________________ Address: ___ __________________________________________________________________________________________City:_______________________________________________ State:_______________ Zip Code:_________________ Home Telephone:______________________________ Work Telephone:_ _____________________________E-mail Address: ____________________________________________________________________________________

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Page 2 of 1 – U.S. Department of Education, Office for Civil Rights DiscriminationComplaint Form, Consent Form, and Complaint Processing Procedures 3. OCR investigates discrimination complaints against institutions and agencies whichreceive funds from the U.S. Department of Education and against public educationalentities and libraries that are subject to the provisions of Title II of the Americanswith Disabilities Act. Please identify the institution or agency that engaged in thealleged discrimination. If we cannot accept your complaint, we will attempt to referit to the appropriate agency and will notify you of that fact.Name of Institution: _______________________________________________________________________________ Address: _____________________________________________________________________________________________ City:_______________________________________________ State:___ Zip Code:_________________ ____________ Department/School: ______________________________________________________________________________ 4. The regulations OCR enforces prohibit discrimination on the basis of race, color,national origin, sex, disability, age or retaliation. Please indicate the basis of yourcomplaint:Discrimination based on race (specify)_____________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Discrimination based on color (specify)_____________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Discrimination based on national origin (specify)______________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________ Discrimination based on sex (specify)_____________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Page 3 of 1 – U.S. Department of Education, Office for Civil Rights DiscriminationComplaint Form, Consent Form, and Complaint Processing Procedures Discrimination based on disability (specify)______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Discrimination based on age (specify)______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Retaliation because you filed a complaint or asserted your rights (specify)______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Violation of the Boy Scouts of America Equal Access Act (specify)______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 5. Please describe each alleged discriminatory act. For each action, please include thedate(s) the discriminatory act occurred, the name(s) of each person(s) involved and,why you believe the discrimination was because of race, disability, age, sex, etc. Alsoplease provide the names of any person(s) who was present and witnessed theact(s) of discrimination.______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Page 4 of 1 – U.S. Department of Education, Office for Civil Rights DiscriminationComplaint Form, Consent Form, and Complaint Processing Procedures 6. What is the most recent date you were discriminated against?Date:_______________________________________________________________________________ 7. If this date is more than 180 days ago, you may request a waiver of the filingrequirement.I am requesting a waiver of the 180-day time frame for filing this complaint.Please explain why you waited until now to file your complaint. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 8. Have you attempted to resolve these allegations with the institution through aninternal grievance procedure, appeal or due process hearing?YES NOIf you answered yes, please describe the allegations in your grievance or hearing, identify the date you filed it, and tell us the status. If possible, please provide us with a copy of your grievance or appeal or due process request and, if completed, the decision in the matter. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 9. If the allegations contained in this complaint have been filed with any other Federal,state or local civil rights agency, or any Federal or state court, please give details anddates. We will determine whether it is appropriate to investigate your complaintbased upon the specific allegations of your complaint and the actions taken by theother agency or court.Agency or Court:_________________________________________________________________________ Date Filed: ___________________ Case Number or Reference: __________________________________________________________ Results of Investigation/Findings by Agency or Court: ______________________________________________________________________________________________ ______________________________________________________________________________________________

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Page 5 of 1 – U.S. Department of Education, Office for Civil Rights DiscriminationComplaint Form, Consent Form, and Complaint Processing Procedures 10. If we cannot reach you at your home or work, we would like to have the name andtelephone number of another person (relative or friend) who knows where andwhen we can reach you. This information is not required, but it will be helpful tous.Last Name:____________________ First Name: Middle Name:___________________ ____________________ Home Telephone__ Work Telephone:______________________________ ____________________________ 11. What would you like the institution to do as a result of your complaint — whatremedy are you seeking?______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 12. We cannot accept your complaint if it has not been signed. Please sign and dateyour complaint below.___________ __________________________________________ (Date) (Signature) ___________ __________________________________________ (Date) (Signature of person in Item 2) Please mail the completed and signed Discrimination Complaint Form, your signed consent form and copies of any written material or other documents you believe will help OCR understand your complaint to the OCR Enforcement Office responsible for the state where the institution or entity about which you are complaining is located. You can locate the mailing information for the correct enforcement office on OCR’s website at http://wdcrobcolp01.ed.gov/CFAPPS/OCR/contactus.cfm.

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Updated April 2014 CONSENT FORM - FOR REVEALING NAME AND PERSONAL INFORMATION TO OTHERS (Please print or type except for signature line) Your Name: __________________________________________________________________________ Name of School or Other Institution That You Have Filed This Complaint Against: ___________________________________________________________________________________________________ This form asks whether the Office for Civil Rights (OCR) may share your name and other personalinformation when OCR decides that doing so will assist in investigating and resolving your complaint.For example, to decide whether a school discriminated against a person, OCR often needs to reveal thatname and other personal information to employees at that school to verify facts or get additionalinformation. When OCR does that, OCR informs the employees that all forms of retaliation against thatperson and other individuals associated with the person are prohibited. OCR may also reveal name and personal information during interviews with witnesses and consultations with experts.If OCR is not allowed to reveal your name or personal information as described above, OCR may decide toclose your complaint if OCR determines it is necessary to disclose your name or personal information inorder to resolve whether the school discriminated against you.NOTE: If you file a complaint with OCR, OCR can release certain information about your complaint to the press orgeneral public, including the name of the school or institution; the date your complaint was filed; the type ofdiscrimination included in your complaint; the date your complaint was resolved, dismissed or closed; the basicdecision; or other related information. Any information OCR releases to the press or generalpublic will not include your name or the name of the person on whose behalf you filed the complaint.NOTE: OCR requires you to respond to its requests for information. Fand resolution activities could result in the closure of your complaint.Please sign section A or section B (but not both) and return to OCR: If you filed the complaint on behalf of yourself, you should sign this form.If you filed the complaint on behalf of another specific person, that other person should sign this form.EXCEPTION: If the complaint was filed on behalf of a specific person who is younger than 18 years old or alegally incompetent adult, this form must be signed by the parent or legal guardian of that person.If you filed the complaint on behalf of a class of people, rather than any specific person, you should sign the form.A. I give OCR my consent to reveal my identity (and that of my minor child/ward on whose behalf thecomplaint is filed) to others t and enforcement activities._____________________________________ ___________________Signature DateORB. I do not give OCR my consent to reveal my identity (and that of my minor child/ward on whosebehalf the complaint is filed) to others. I understand that OCR may have to close my complaint._____________________________________ ___________________Signature DateI declare under penalty of perjury that it is true and correct that I am the person named above; and, if the complaint is filed on behalf of a minor child/ward, that I am This declaration only applies to the identity of the persons and does not extend to any of the claims filed in the complaint.