APPENDIX A-1

North Providence School District

Grievance #__________

Copy #______________

Fill Out two (2) copies for every grievance.

This form may be used for General Grievances, if so specified

A.F.T LOCAL 920. AFL-CIO

NORTH PROVIDENCE SCHOOL DEPARTMENT

NAME: _______________________________

DATE: ___________

SCHOOL: _________________________

NATURE OF GRIEVANCE:

Under the provisions of the Collective Bargaining Agreement between the North Providence School Committee and the North Providence Federation of Teachers __________________ has been aggrieved as follows:

TEACHER'S SIGNATURE: ______________________

UNION REPRESENTATIVE: _____________________