Evaluation Grievance Process - Step III

RUTHERFORD COUNTY SCHOOLS

 

Evaluation Grievance Form - Step III

 

This form must be completed by the grievant and submitted to the Board of Education no later than fifteen (15) days following the decision at Step II.

 

Name of Grievant:  __________________________________________________

 

School:  ___________________________________________________________

 

Name of Evaluator:  _________________________________________________

 

Date Director's Decision Received:  __________ Evaluation Period:  __________

 

Basis for grievance:  Identify the inaccurate data that was used or describe the procedural error that occurred as pat of your evaluation.  Explain how this inaccurate data or procedural error materially affected or compromised your evaluation.  ________________________________________________________________________

 

________________________________________________________________________

(Attach additional sheets or documentation as needed)

 

Corrective Action Desired:  _________________________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

Signature of Grievant:  _____________________________________________________

 

TO BE COMPLETED BY THE EVALUATOR

 

Date received:  ____________ Director's Decision:  Confirmed _______ Denied_______

 

Full Board Hearing Granted:  No ______ Yes ______ and set for ___________________      (Date and Time)

 

Other Corrective Action Taken: ______________________________________________

 

________________________________________________________________________

 

Signature of Board Chair:  __________________________________________________

 

Date grievant notified:  __________________________