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102E3 Grievance Documentation

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