Teen Court Volunteer Grievance Form

Date _____________________

Volunteer Name_______________________ ID Number __________________

Title ______________________Department ____________________

State your grievance in detail, including the date of acts(s) or omissions causing grievance. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________.

Identify other individuals with personal knowledge of your grievance ____________________________________________________________________ ____________________________________________________________________

State briefly your efforts to resolve this grievance. ______________________________ ____________________________________________________________________

Describe the remedy or solution you would like to occur.

________________________________________________________________________________________________________________________________________________

Volunteer's Signature _________________________ Date _____________

Grievance Committee Member - Informal Review Date Received ______________________ ___________________________________________________________________.

Actions Taken _________________________________________________________ ____________________________________________________________________.

Disposition ___________________________________________________________

Volunteer Accepted [ ] Appealed [ ]

Assigned Team Member _____________ Date Notified _____________

Grievance Committee - Formal Review

Date Received _________________________________________________________

Actions Taken _________________________________________________________ ____________________________________________________________________

Disposition ___________________________________________________________

Volunteer Accepted [ ] Appealed [ ]

Grievance Review Committee _________________________________________________ ___________________________ Date Notified _________________________

Grievance Committee and Administration - Formal Review

Date Received _________________________________________________________

Actions Taken _________________________________________________________ _____________________________________________________________________

Disposition ____________________________________________________________

Volunteer Accepted [ ] Appealed [ ]

Administrative Team ______________________________________________________ ___________________ Date Notified ________

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