102.E2 GRIEVANCE FORM FOR COMPLAINTS OF DISCRIMINATION OR NON-COMPLIANCE WITH FEDERAL OR STATE REGULATIONS REQUIRING NON-DISCRIMINATION

I,                                , am filing this grievence because

 

 

(Attach additional sheets if necessary)

Describe incident or accurrence as accurately as possible:

 

 

(Attach additional sheets if necessary)

 

Signature

Address

Phone Number

If student, name                              Grade Level

Attendance center