Arlington Independent School District Employee Complaint Form Level One
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6Arlington Independent School District
Employee Complaint Form
Level One
Complete this form in accordance with District policy DGBA (LOCAL). Your complaint
will be dismissed if it is submitted with incomplete information. Submit your Level One
complaint to your campus principal, immediate supervisor, or other person specified in
policy DGBA (LOCAL).
1. Name ______________________________________________________________
2. Position/Campus ____________________________________________________
3. The date of the event or action that gave rise to this complaint __________
4. A detailed factual description of all of the circumstance(s) that gave rise to this
complaint. (Use additional pages if necessary.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Explain specifically how you were harmed or injured by the facts that you provided in
response to item 4 above.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. Specifically identify, and attach if possible, any documents upon which you will rely
during the grievance process and explain what those documents will prove. (If you do
not have these documents at the time you file your grievance, you will be able to
provide copies at the Level One conference. However, please identify to the best of
your ability what those documents are and what you think they will prove.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. Identify the specific policy or policies, constitutional or statutory provision, or
administrative regulations that you allege have been misapplied or the specific type of
discrimination that you allege was committed. For each, provide the facts that
support your allegations.
AISD Complaint Forms
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