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2. Town of Frederick's Grievance Form
4. Name of Grievant*
6. Person Preparing Complaint (if different from Grievant)
7. Relation of Preparer to Grievant (if applicable)
9. Address of Grievant*
10. City*
11. State*
12. Zip*
14. Phone Number of Grievant*
15. Email of Grievant*
17. Nature of Grievance
19. Please provide a complete description of the specific complaint or grievance, including any incident, barrier, or perceived denial of benefit of any service, program, or activity:*
21. Please specify any location(s) related to the complaint or grievance (if applicable):*
23. Please state what you think should be done to resolve the complaint or grievance:*
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25. 1. Receive an email copy of this form.
26. Email address

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27. Submit

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