Code No. 102E3
GRIEVANCE DOCUMENTATION
Name of Individual Alleging Discrimination or Non-Compliance: ________________________________
Grievance Date: _________________________
State the nature of the complaint and the remedy requested: _____________________________________
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Indicate Principal’s or Supervisor’s response or action to above complaint: ________________________
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Signature of Principal or Supervisor: _______________________________________________________
All complaints will be taken seriously and followed up with a written response to the person who has completed this form. Following the completion of the response, the person completing this form will receive a copy and this will be entered into the district’s file in the event that it needs to be referenced at a later date. If the person who completes this form is not satisfied with the response, they should contact the District Superintendent at 641-236-2700. This form will be used to investigate the manner of the complaint.
Approved: 02/26/14
Reviewed:
Revised: 04/14/2021