103.E2 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

 

______________________________________________

---------------------------------------------------------------------------------------------------------------------

Approved

Reviewed 11/12/18

               Revised