Community Relations SECTION 504 GRIEVANCE PROCEDURES. Sanger Unified School District SECTION 504 GRIEVANCE FORM LEVEL 1 (Form A)

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1 Exhibit SANGER UNIFIED SCHOOL DISTRICT E (a) Community Relations GRIEVANCE PROCEDURES GRIEVANCE FORM LEVEL 1 (Form A) GRIEVANCE PROCESS: Level One: Site 504 Coordinator Many problems can be solved with a meeting or the parties and the site 504 Coordinator. An individual with a complaint related to the Section 504/ADA procedures is encouraged to first discuss it with the school site 504 coordinator. If informal discussion fails to resolve the concern, a Level One grievance can be filed. The school site 504 Coordinator will respond in writing within ten (10) working days. I, am filing this grievance because Describe incident or occurrence as accurately as possible (include date of incident or occurrence). STUDENT NAME: SCHOOL: ADDRESS: PHONE NUMBER: Signed: (Grievant) Person receiving grievance: : : Copy: Parent, District 504 Coordinator

2 E 9270(b) LEVEL 1: GRIEVANCE RESPONSE- (FORM A1) Many problems can be solved with a meeting or the parties and the site 504 Coordinator. An individual with a complaint related to the Section 504/ADA procedures is encouraged to first discuss it with the school site 504 coordinator. If informal discussion fails to resolve the concern, a Level One grievance can be filed. The school site 504 Coordinator will respond in writing within ten (10) working days. Name (individual alleging 504/ADA discrimination or non-compliance): of Grievance Filing: Summarize the nature of the complaint and the remedy requested: Indicate site 504 Coordinator s response or action to the complaint: Signature of site 504 Coordinator: : Copy: Parent, District 504 Coordinator

3 E 9270(c) GRIEVANCE DOCUMENTATION LEVEL TWO: DISTRICT 504 COORDINATOR (FORM B) Level Two: Section 504/ADA District Coordinator If the grievance is not resolved at Level One, the grievant may file a Level Two written grievance stating: 1) The nature of the grievance; 2) The remedy requested; and 3) Be signed and dated by the grievant. The Level Two grievance must be filed with the District Coordinator with in fifteen (15) working days of the receiving site 504 Coordinator s decision. The Section 504/ADA District Coordinator will respond, in writing, within seven (7) working days. Name of Grievant: : Summary of Grievance, Level One Response, and remedy sought: FOR 504 DISTRICT COORDINATOR RESPONSE Actions taken review at Level Two: Decision at Level Two: District 504 Coordinator

4 E 9270(d) GRIEVANCE DOCUMENTATION LEVEL THREE: SUPERINTENDENT- (FORM C) Level Three: Superintendent If the complaint is not resolved at Level Two, the grievant may file a Level Three grievance by presenting a written appeal to the Superintendent of Schools within ten (10) working days after the grievant receives the Level Two decision from the District 504 Coordinator. The grievant may request a meeting with the Superintendent or with his/her designee. The Superintendent of or her/his designee has the option of meeting with the grievant to discuss the appeal. A decision will be returned to the grievant by the Superintendent or his/her designee within ten (10) working days of the receipt of the appeal. Name of Grievant: : Summary of Grievance and Level Two Response: FOR SUPERINTENDENT RESPONSE Actions taken in Review at Level Three: For ffseioau Decision at Level Three: Superintendent/Designee Signature

5 E 9270(e) LEVEL FOUR: REQUEST FOR IMPARTIAL HEARING- (FORM D) Level Four: Impartial Hearing Should none of the previous steps resolve the matter, the grievant may file a written request with the District 504 Coordinator for an impartial hearing. All requests for a hearing must be filed with the District 504 Coordinator within ten (10) days of the receipt of the Level Three decision. The District 504 Coordinator shall arrange for an impartial hearing officer within fifteen (15) working days of receipt of the request. The hearing will be conducted in accordance with the procedures and regulations of the Family Education Rights and Privacy Act. The hearing officer will render a decision solely on the evidence presented at the hearing shall provide a summary of the evidence and a rationale for the decision to all relevant parties. At any point in the process, the grievant may communicate with the U.S. Department of Education, Office of Civil Rights: U.S. Department of Education 400 Maryland Ave. SW Washington, D.C California Office of Civil Rights: Web site: civilrights@spb.ca.gov Main line: (916) FAX: (916) Grievant Name: of Level Four Hearing Request: I,, am requesting a Level Four Section 504 impartial hearing with a neutral facilitator arranged through the District 504 Coordinator The reason for this request is: District 504 Coordinator