Special Circular 6 Grievance Form Step 1
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1SPECIAL CIRCULAR 6--GRIEVANCE FORM: STEP ONE
NAME________________________________ FILE #_____________________
SCHOOL_____________________________ DISTRICT/REGION__________
DATE GRIEVANCE OCCURRED ________ UFT CASE # _______________
HOME TEL.#_____________________CELL TEL. #_____________________
EMAIL ADDRESS_________________________
SET FORTH SPECIFICALLY THE ACT OR CONDITION AND THE GROUNDS ON
WHICH THE GRIEVANCE IS BASED:
CHECK THE APPROPRIATE BOX(ES)
The Principal, ________________, has failed to consult with the Chapter to discuss the number of positions
for each of the menu activities.
The Principal, ________________, has failed to consult with the Chapter to discuss the qualifications for
each of the menu activities.
The Principal, ________________, has improperly created additional menu activites.
The Principal, ________________, has failed to provide teachers a menu of activites to select from by
_____________________(date).
The Principal, ________________, has failed to notify teachers of their professional activity by
_____________________(date).
I have selected AM or PM bus duty and have not been allowed to use my professional period as a preparation
period.
I have been denied the right to select homeroom as my professional activity.
I have not been assigned to any of my three (3) or six (6) choices as a professional activity for the
_______________________ school year/term.
I have not been assigned my preference of ________________, even though I am the most senior qualified
candidate for that menu item.
I have been involuntarily assigned to an administrative assignment even though I am not the least senior
teacher.
I have been involuntarily assigned to an administrative activity for two consecutive years.
I have been denied the right to use my professional period to fulfill the duties of my Compensatory Time
Position.
I have been denied the right to use my professional period to fulfill the duties of my athletic coaching per
session activity.
OTHER:________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________
_________________________________________
SET FORTH THE SPECIFIC ARTICLE(S) AND SECTION(S) ALLEGED TO BE
VIOLATED:
The above cited act(s) which was/were not resolved in conference with the supervisor,
_____________________________________, is/are in violation of Article(s) _________________
.
_________________________________________________________________of the Agreement
The remedy I seek is_____________________________________________________________
______________________________________________________________________________.
___________________________________
____________________________________
DATE FILED
SIGNATURE OF GRIEVANT
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