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Tort Claim Form

Colfax School District

1110 NORTH MORTON ST

COLFAX, WA 99111

district

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In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information OSPI Child Nutrition Services June 2022 (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720- 2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf , from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by: mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; or fax: (833) 256-1665 or (202) 690-7442; or email: program.intake@usda.gov This institution is an equal opportunity provider.” Title IX Coordinator Jerry Pugh, Superintendent 1207 North Morton Street, Colfax WA 99111 509-397-3042 jerry.pugh@csd300.org Section 504/ADA Coordinator Mrs. Amber Sellars, School Nurse 1207 North Morton Street, Colfax WA 99111 509-397-2181 amber.sellars@csd300.org Civil Rights Compliance Coordinator Jerry Pugh, Superintendent 1207 North Morton Street, Colfax WA 99111 509-397-3042 jerry.pugh@csd300.org

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