Code No. 102.5

School District

Grievance Documentation

Name of Individual alleging discrimination or Non-compliance

Name                                                                         

Grievance Date                                                         

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:      February 26, 1996             

Reviewed:      January 16, 2006              

Revised: