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Submit a Title IX Complaint

Welcome to the Centralia School District Title IX Incident Report Form. Please provide our office with as much detail abuot the incident as possible.

If you have any questions about this form, please contact the Title IX Coordinator, 360.330.7600.

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Contact Information

Reporter's Name*

Answer Required

Reporter's Email *

Answer Required

Reporter's Phone*

Number Required

Date of Incident *

Answer Required

Time of Incident *

Answer Required

Incident Description *

Answer Required

Location of Incident *

Answer Required

Accused Students/Staff*

Answer Required

Complainant(s)/Victim(s)*

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Other Students/Witnesses*

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Confirmation Email

Email Required