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VVTA Grievance Worksheet
please fill out the following questionnaire:
*
Indicates required field
Name
*
First
Last
[object Object]
Personal Email
*
Fill in the phone number where you prefer to be contacted.
Home Phone Number
*
Cell Phone Number
*
Your classroom phone extension
*
Site
*
Position (please check all that apply)
*
Teacher
Counselor
Teacher on Assignment
Site Representative
Please keep this anonymous
Today's Date
*
Date(s) of incident
*
What is the date (or approximate date) of the incident or the date that you first became aware that there was a problem.
Describe the complaint in detail.
*
What was the incident? Who was involved? Where did the incident occur?
Timelines are very important:
Before a formal grievance can be filed, you (or someone speaking on your behalf such as a site rep or grievance team member) need to attempt to resolve it by
i
nformal conference(s
)
with your immediate supervisor
within
fifteen (15) days
after the occurrence of the act or omission giving rise to the grievance,
If ten (10) days after the first meeting, the alleged violation is not resolved by informal conference(s),we can submit a formal grievance to Level 1,
Date that your immediate supervisorwas first made aware of the complaint
*
Your immediate supervisor could be your site principal, an assistant principal, a dean. If your issue is at the district level, this could be any of the assistant superintendents or the superintendent. Your immediate supervisor will NEVER be another certificated person (teacher or counselor) and will NEVER EVER be a classified person.
Name of your immediate supervisor
*
Who first made your immediate supervisor aware of this situation?
*
This could be a you, a site rep., a member of the exec board/grievance, another teacher/counselor , a classified person.
Exactly how was your immediate supervisor made aware of your complaint?
*
A casual meeting? A formal meeting? By phone? By email? Who was there? A site rep? Another administrator? Anyone else?
What response did you receive, if any
*
Date of any response you may have received
*
What resolution would you like to see to this complaint?
*
When and how is the best way to contact you
*
Before school? After school? Lunch (when?), at home, your prep period (if possible--we could be teaching our own classes)
Do you have any questions?
*
Submit Grievance
If you have any questions about this grievance, feel free to contact me.
Amanda Ballard at
[email protected]