FILE:  GAE-E

Cf:   GAE

GRIEVANCE FORM

Grievance # ________________________        Date ___________________________

(To be completed by administrator)

Name of Grievant ______________________________________________________

Job Site ___________________________        Position ________________________

1.         Date Grievance Occurred __________________________________________

2.         Statement of Grievance (Specify provision of law, policy or regulation)

            _______________________________________________________________

            _______________________________________________________________

            _______________________________________________________________

            _______________________________________________________________

3.         Identify Specific Relief Sought

            _______________________________________________________________

            _______________________________________________________________

            _______________________________________________________________

__________________________________        _______________________________

Signature of Grievant                                                Date

Disposition by Responsible Official

________________________________________________________________

________________________________________________________________

________________________________________________________________

_________________________________          ________________________________

Signature of Official                                                  Date

Acadia Parish School Board