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Grievance forms for Level One requests should be submitted to the employee s principal or immediate supervisor. Humble Independent School District Employee Grievance Form Print Form Any employee who wishes to file a grievance must fill out this form completely. Grievance forms for Level Two and Level Three requests should be submitted directly to the Superintendent s office. All grievances will be processed in accordance with policies DGBA and DGBA LOCAL. Name Position/Campus Please state date of event or series of events causing the grievance Please state your grievance including the individual harm alleged Please state specific facts of which you are aware to support your grievance List in Detail Please specify what remedy you are seeking If you are making complaints or charges against any spedific individuals please identify each of those individuals by name If you will be represented in presenting your complaint please identfiy the name address and telephone number of that individual or organizations Phone Address Are you alleging a violation of the Texas Whistleblower Act Signature Yes Date Submitted No. Grievance forms for Level Two and Level Three requests should be submitted directly to the Superintendent s office. All grievances will be processed in accordance with policies DGBA and DGBA LOCAL. Name Position/Campus Please state date of event or series of events causing the grievance Please state your grievance including the individual harm alleged Please state specific facts of which you are aware to support your grievance List in Detail Please specify what remedy you are seeking If you are making complaints or charges against any spedific individuals please identify each of those individuals by name If you will be represented in presenting your complaint please identfiy the name address and telephone number of that individual or organizations Phone Address Are you alleging a violation of the Texas Whistleblower Act Signature Yes Date Submitted No.

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