Uniform Grievance Procedure
Concern You Would Like Addressed
(Please keep your presentation to one sheet. Thank you.)
Name: Date:
Mailing Address:
Phone Number(s):
Subject:
Problem:
Examples that validate the problem:
Results:
Suggested Solutions:
Response Date:
Person Responding:
Response to Concern
Person Responding: ______________________________ Response Date: ____________
Method used to communicate response:
Actions Taken to Investigate Concern:
People contacted in gathering information upon which to make decision:
Findings of the Investigation:
Decision:
Results of communicating the decision:
Signature of Respondent Date