Illinois State University

Laboratory Schools

  Grievance Form

Name of Grievant _____________________________________________________________

                                                            (Please print or type)  

Department/Office _________________________________________________________

Campus Box ______________________________________________________________

Phone Number ____________________________________________________________

Grievance Filed Against:

        Name ___________________________________________________________________

Department/Office _________________________________________________________

Campus Box ______________________________________________________________

Phone Number ____________________________________________________________

Nature of Grievance:

Proposed Resolution:

      ____________________________________________                  _________________

                           Signature of Grievant                                                      Date

Transmit this document to the Grievance Review Administrator (Superintendent's Office, Campus Box 5300)

within five (5) working days of date discussed with the Respondent.