Skip Navigation Linc Search Site Map Get Help With This Site
My LINCS: make LINCS work for you Discussions: on-line lists on literacy issues HOT Sites: recommended literacy sites Collections: high quality resources by subject
Policy & Procedure Manual for Serving Students
with Learning Disabilities and/or Attention Deficit Hyperactivity Disorder
Appendix G

Sample Grievance Procedure Form

[Insert your program's name] has adopted an internal grievance procedure providing prompt and equitable resolution of complaints for members of the public, visitors, clients, and employees not covered under existing agency's grievance procedure alleging any action prohibited by the U.S. Department of Justice regulations implementing Title II of the Americans with Disabilities Act. Title II states, in part, that "...no otherwise qualified disabled individual shall, solely by reason of such disability, be excluded from the participation in, be denied the benefits for, or be subjected to discrimination..." in programs or activities sponsored by a public entity.
  1. A complaint shall be filed in writing or verbally contain the name and address of the person filing it, and briefly describe the alleged violation of the regulations.
  2. A complaint shall be filed within five (5) working days after the complainant becomes aware of the alleged violation. Processing of allegations of discrimination, which occurred before this grievance procedure was in place, will be considered on a case-by-case basis.
  3. An investigation, as may be appropriate, shall follow a filing of complaint. The investigation shall be conducted by [Insert name of ADA Coordinator] or in [his/her] absence, any other person designated by the program or agency director. This process contemplates informal by thorough investigations, affording all interested persons and their representatives, if any, an opportunity to submit information relevant to a complaint.
  4. A written determination as to the validity of the complaint and a description of the resolution, if any, shall be issued by [Insert name of ADA Coordinator] or the person designated by the program or agency director, and a copy forwarded to the complainant no later than ten (10) working days after its filing.
  5. The ADA Coordinator shall maintain the files and records of [Insert your program's name] relating to the complaints filed.
  6. The complaint can request a reconsideration of the case in instances where he or she is dissatisfied with the resolution. The request for reconsideration must be made within five (5) working days to [Insert name, address, and phone number of program or agency director].
  7. The right of a person to a prompt and equitable resolution of the complaint filed hereunder shall not be impaired by the person's pursuit of other remedies such as the filing of an ADA complaint with the responsible federal department or agency.
  8. Use of this grievance procedure is not a prerequisite to the pursuit of other remedies.
  9. This entire process shall be constituted to protect the substantive rights of interested persons to meet appropriate due process standards and to assure that the [Insert name of Program] complies with the ADA and implementing regulations.
This will certify that [Insert name of ADA Coordinator] will serve [Insert name of Program] as the Coordinator/Counselor for:
Date   Signature of Program or Agency Director
  • Contact the AALRC
  • National LINCS
  • About LINCS
  • National Institute for Literacy
  • Western/Pacific LINCS
  • Northwest LINCS
  • Midwest LINCS
  • Eastern LINCS
  • Southern LINCS

Arkansas is a member of LINCS (Literacy Information aNd Communication Systems) which provides a Regional and National network of electronic support for Adult Education and Literacy. Arkansas is part of the Southern LINCS consortium. Click on the buttons below to search for resources outside of Arkansas.

Funded by the Arkansas Department of Workforce Education, Adult Education Section

AALRC.org. All Rights Reserved. © 2006
Site redesigned by: Mass Enthusiasm