Common use of Distribution of Forms Clause in Contracts

Distribution of Forms. 1. Employee 3. Administrator/Supervisor 5. School Board 2. Association 4. Superintendent/Designee 6. Arbitrator NAME OF GRIEVANT: Classification: Work Location: LEVEL ONE: Statement of Grievance: Relevant Agreement (Contract) Provision(s): Date Grievance Occurred: Relief Sought: Signature of Grievant: Date: Date of Level One Decision: Disposition: LEVEL TWO: Date Written Grievance Filed With Immediate Administrative Supervisor: Disposition of Immediate Administrative Supervisor: Signature of Immediate Admin. Supervisor: Date: Position of Grievant and/or Association: Signature: Date: LEVEL THREE: Date Written Grievance Filed With Superintendent or Designee: Disposition of Superintendent or Designee: Signature of Superintendent or Designee: Date: Position of Grievant and/or Association: Signature: Date: LEVEL FOUR: Date Written Grievance Filed With Board of Education: Disposition of Board of Education: Signature: Date: Position of Association: Signature: Date: LEVEL FIVE: Date the District Notified of Decision to File/Not File for Arbitration: Date Filed for Arbitration: Date Grievance Withdrawn and Not Filed for Arbitration: Signature: Date: THIS PAGE WAS LEFT BLANK BY DESIGN APPENDIX D

Distribution of Forms. 1. Employee 3. Administrator/Supervisor 5. School Board 2. Association 4. Superintendent/Designee 6. Arbitrator NAME OF GRIEVANT: Classification: Work Location: LEVEL ONE: Statement of Grievance: Relevant Agreement (Contract) Provision(s): Date Grievance Occurred: Relief Sought: Signature of Grievant: Date: Date of Level One Decision: Disposition: LEVEL TWO: Date Written Grievance Filed With Immediate Administrative Supervisor: Disposition of Immediate Administrative Supervisor: Signature of Immediate Admin. Supervisor: Date: Position of Grievant and/or Association: Signature: Date: LEVEL THREE: Date Written Grievance Filed With Superintendent or Designee: Disposition of Superintendent or Designee: Signature of Superintendent or Designee/Designee: Date: Position of Grievant and/or Association: Signature: Date: LEVEL FOUR: Date Written Grievance Filed With Board of Education: Disposition of Board of Education: Signature: Date: Position of Association: Signature: Date: LEVEL FIVE: Date the District Notified of Decision to File/Not File for Arbitration: Date Filed for Arbitration: Date Grievance Withdrawn and Not Filed for Arbitration: Signature: Date: THIS PAGE WAS LEFT BLANK BY DESIGN APPENDIX DLETTER(S) OF UNDERSTANDING

Distribution of Forms. 1. Employee 1.Employee 3. Administrator/Supervisor 5. School Board 2. Association 2.Association 4. Superintendent/Designee 6. Arbitrator NAME OF GRIEVANT: Classification: Work Location: LEVEL ONEONE Date of Level One Meeting: Disposition: Statement of Grievance: Relevant Agreement (Contract) Provision(s): Relief Sought: Date Grievance Occurred: Relief Sought: Signature of Grievant: Date: Date of Level One Decision: Disposition: LEVEL TWOTWO CONTINUED: Date Written Grievance Filed With with Immediate Administrative Supervisor: Disposition of Immediate Administrative Supervisor: Signature of Immediate Admin. Administrative Supervisor: Date: Position of Grievant and/or Association: Signature: Date: LEVEL THREE: THREE Date Written Grievance Filed With Superintendent or with Superintendent/Designee: Disposition of Superintendent or Designee: Signature of Superintendent or Superintendent/Designee: Date: Position of Grievant and/or Association: Signature: Date: LEVEL FOUR: FOUR Date Written Grievance Filed With with Board of Education: Disposition of Board of Education: Signature: Date: Position of Association: Signature: Date: LEVEL FIVE: FIVE Date the District Notified of Decision to File/Not File for Arbitration: Date Filed for Arbitration: Date Grievance Withdrawn and Not Filed for Arbitration: Signature: Date: THIS PAGE WAS LEFT BLANK BY DESIGN APPENDIX D

Distribution of Forms. 1. Employee 1.Employee 3. Administrator/Supervisor 5. School Board 2. Association 2.Association 4. Superintendent/Designee 6. Arbitrator NAME OF GRIEVANT: Classification: Work Location: LEVEL ONEONE Date of Level One Meeting: Disposition: Statement of Grievance: Relevant Agreement (Contract) Provision(s): Relief Sought: Date Grievance Occurred: Relief Sought: Signature of Grievant: Date: Date of Level One Decision: Disposition: LEVEL TWOTWO CONTINUED: Date Written Grievance Filed With with Immediate Administrative Supervisor: Disposition of Immediate Administrative Supervisor: Signature of Immediate Admin. Administrative Supervisor: Date: Position of Grievant and/or Association: Signature: Date: LEVEL THREE: THREE Date Written Grievance Filed With Superintendent or with Superintendent/Designee: Disposition of Superintendent or Designee: Signature of Superintendent or Superintendent/Designee: Date: Position of Grievant and/or Association: Signature: Date: LEVEL FOUR: FOUR Date Written Grievance Filed With with Board of Education: Disposition of Board of Education: Signature: Date: Position of Association: Signature: Date: LEVEL FIVE: FIVE Date the District Notified of Decision to File/Not File for Arbitration: Date Filed for Arbitration: Date Grievance Withdrawn and Not Filed for Arbitration: Signature: Date: THIS PAGE WAS LEFT BLANK BY DESIGN APPENDIX DLETTER(S) OF UNDERSTANDING