Fillable Student Grievance Form (Anchorage School District)

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Student Grievance Form (Anchorage School District)

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Anchorage School District
Educating Students for Success in Life
EEO #003 Compliance/EEO ph. 907-742-4131 Rev. 09/2018
Student Grievance Form
1. Name of student: _______________________________________
2. Email address: _________________________________________
3. Phone number: ________________________________________
4. Name of person(s) the complaint is about: ___________________
____________________________________________________
5. Date of incident(s): _____________________________________
6. Nature of incident (s): Sex-based Harassment Other
7. Please describe your concern(s) in the space provided. You may
provide additional information or attachments, as necessary.
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Once completed, please save (or print) this form and deliver to the Compliance/EEO
Office by email to EEO@asdk12.org
, or by fax to 907-742-4226.
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Student Grievance Form (Anchorage School District)

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Completed 14 June 2021

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