FILE:  GAE-E

WASHINGTON PARISH SCHOOL SYSTEM

STATEMENT OF EMPLOYEE GRIEVANCE

NAME OF GRIEVANT: __________________________________________________

SCHOOL/WORK LOCATION: ____________________________________________

A grievance is a claim by an employee or group thereof that he/she has suffered harm or injury by the interpretation, application or violation of a contract, a School Board policy, a law or constitutionally guaranteed rights.  The term grievance does not include matters for which the method of review is prescribed by law or where the School Board is without authority to act. [File: GAE]

Consistent with this definition, please provide all of the following information.

1. What contract, School Board policy, law or constitutionally guaranteed right do you claim has been misinterpreted, misapplied or violated?
   
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2. How was that contract, School Board policy, law or constitutionally guaranteed right misinterpreted, misapplied or violated?  [Please provide a detailed listing of all facts that you feel support your position.]
   
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3. How has the alleged violation outlined in question 2 above caused harm or injury to you?
   
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4. Who do you feel can provide information to school officials in support of your position in this grievance?  [Please note that these individuals may be interviewed and asked to submit signed statements during the grievance process.]
   
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5. What relief are you requesting with this grievance?
   
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6. Will you be presenting your own grievance or have you designated someone to represent you?  If the latter, who has been so designated?
   
   ________________________________________________________________
   
   ________________________________________________________________
   
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We/l certify that the information provided hereinabove is true and correct to the best of our/my knowledge, information and belief.

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Signature of Grievant                                                                                              Date

Washington Parish School Board