104.3 Grievance Documentation

GRIEVANCE DOCUMENTATION

Name of Individual Alleging Discrimination or Non-Compliance:

 

Name                                      ______________________________________________

 

Signature                                ______________________________________________

 

Date of Grievance                     ______________________________________________

State the nature of the complaint and the remedy requested.

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

                                                                                                                                                                                                                          

Indicate Principal's or Supervisor's response or action to above complaint.

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

                                                                                                                                                                                                                         

 

 

Signature of Principal or Supervisor ______________________________________________