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)
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Describe incident or occurrence as accurately as possible: (Attach additional sheets if necessary)
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Signature_________________________________________________
Address__________________________________________________
Phone Number ____________________________________________
If student,
Name ____________________________________________ Grade Level ______________
