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Appendix
ENFIELD PUBLIC SCHOOLS
Enfield, Connecticut
Discrimination Grievance Form
Any student, parent/guardian, employee or employment applicant who feels that he/she has been
discriminated against on the basis of race, color, age, religion, national origin, ancestry, sex, sexual
orientation, gender identity or expression, marital status, disability or equal access to the Boy
Scouts and other designated youth groups may discuss and/or file a grievance with either of the
Civil Rights Coordinators of the Enfield Public Schools. Reporting should take place within 40
calendar days of the alleged discrimination. Civil Rights Coordinators:
Title IX and Title VI Andrew Longey 860-253-6533
Name
Telephone Number
Section 504 Julie Carroll 860-253-4709
Name
Telephone Number
Name of Presenter/Complainant: ___________________________________________________
Employee ________ Employment Applicant _______ Student ______ Parent/Guardian _______
Home address __________________________________________________________________
Phone _______________ Date of Claim _______________ Date of Incident ________________
1. Statement of Incident/Issue (include all pertinent information: who, how, where, when,
how often, feelings, witness).
2. Please attach any additional information/documentation as necessary.
Signature of Presenter: ___________________________________________________________
Signature of Civil Rights Coordinator: ______________________________________________
Date Received: ____________________
Forms are available from either of the Civil Rights Coordinators, Administrators and
Guidance Offices.
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