Exhibit 106a - Grievance Form for Complaints of Discrimination

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, Grade Level ______________________________________________

If student, Attendance Center

Adopted: 08/18/14
Modified:
Reviewed: 08/04/14; 08/05/19

Legal References:

Cross Reference:
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