102.E2 - Grievance Form for Complaints of Discrimination or Non-Compliance with Federal or State Regulations Requiring Non-Discrimination

I,                                                                    , am filing this grievance because

 

 

 

 

 

 

 

 

 

(Attach additional sheets if necessary)

 

Describe incident or occurrence as accurately as possible:

 

 

 

 

 

 

 

 

 

 

 

 

 (Attach additional sheets if necessary)

 

Signature

 

 

 

Address

 

 

 

Phone Number

 

 

 

If student, name

 

Grade Level

 

Attendance center