Complaint Form

In accordance with West Contra Costa Unified School District Board Policy, the District follows Administrative Regulation 5145.3 (AR5145.3) when addressing complaints alleging failure to comply with applicable State and Federal laws and regulations including, but not limited to, allegations about discrimination, harassment, intimidation, bullying, including sexual and gender-based harassment. A copy of the District's AR 5145.3 is available free of charge.

Please complete the form and answer the following questions to the best of your ability. If you would like help in completing the form, please contact the District's Director of Title IX Educational Equity, Rhonda Haney at (510) 307-4538, by email at, or in person at 1108 Bissell Avenue, Richmond, CA 94801.

Your Contact Information

Alleged Victim Information

Basis of Complaint

My complaint is based on    

Please identify the type(s) of discrimination, harassment, intimidation, bullying or non-compliance leading to your complaint.

Details of Complaint

a) Please describe the type of incident(s) that led to this complaint in as much detail as possible, including all dates and times when the incident(s) occurred (or when the incident(s) first came to your attention) and the specific locations where the incident(s) occurred.

b) Please list the individuals involved in the incident(s):

c) Please list any witnesses to the incident(s):

d) What steps, if any, have you taken to resolve this issue before filing a complaint?