GRIEVANCE INFORMATION FORM

Directions: Please fill out completely. This form will be used for internal purposes only.
Name ________________________________________________
Home Address ________________________________ Home/Cell Phone _______________
Prefer To Be Contacted at: Home __________

School ___________ Cell______________

Current Assignment _________________How Long______ Prior Assignment ______________

How Many Years in District________

Professional Teacher Status: Yes____No____

Nature of Dispute (be specific names, dates, times, places; attach additional pages if needed)
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Remedy Sought _______________________________________________________________
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List specific Article(s)/Section(s) you feel have been violated ____________________________
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Signature

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Date