Policies‎ > ‎J_STUDENTS‎ > ‎

JBA-E Policy_Policy -Equal Educational Opportunities Grievance Procedure Form

Code: JBA-E

EQUAL EDUCATIONAL OPPORTUNITIES GRIEVANCE PROCEDURE FORM

NAME ____________________________________________________________

ADDRESS _________________________________________________________

COMPLAINT CLAIMS DISCRIMINATION BASED ON: RACE                       _____

 SEX                           _____

 AGE                           _____

 NATIONAL ORIGIN_____

 HANDICAP              _____

PHONE _______________________

DATE OF INCIDENT _______________ LOCATION(S) ____________________

_________________________________________________________________

Please describe in full detail, the nature of your complaint.  Include the names of persons involved, if any. 

_________________________________________________________________ 

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

 

Complainant's Signature _________________________________________

Date Grievance Was Filed ________________________________________

Signature of Civil Rights Compliance Officer/Title IX Coordinator ______________________________________________________________________

 

 

Adoption Date: December 21, 2010

Amended: March 21, 2017

Comments