Nondiscrimination -- Grievance Form
E 4030.00
Title VI Compliance Violation, Race Form
Title IX Compliance Violation, Grievance Form
AS 18.80.200-295 Discriminatory Practices Violation, Grievance Form
Section 504 Compliance Violation, Grievance Form
(Actual forms may be downloaded - see "attachments" at right side of page)
I, ____________________ am filing this grievance because
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(Attach additional sheets if necessary)
Describe incident or occurrence as accurately as possible:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.
(Attach additional sheets if necessary)
What remedy are you requesting?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.
___________________________ ______________________________
Grievant's Signature Principal's Signature
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Name of School Date of Filing
KETCHIKAN GATEWAY BOROUGH SCHOOL DISTRICT
Adoption Date: 10/13/99
Revision Date: 3/13/2013
Revision Dates: 1/14/2015, 4/8/2016
7/11/2018