C.M.R. 12, 168, ch. 50, att. 1
Procedures for filing a grievance are described in State of Maine's "Non-Discrimination Policy and Grievance Procedure." While we encourage you to use this grievance process, you also should be aware that the Maine Human Rights Commission is another avenue for investigating cases that are within its jurisdiction. You must file a complaint with that office no later than 180 days after the alleged discriminatory action. (If your grievance is resolved, you may withdraw your Commission complaint.) Call the Commission at (207) 624-6050 (voice) or (888) 577-6690 (TTY) with any questions concerning their process.
Please tell us if you need assistance in preparing this form, or if you need to submit your grievance in a different format.
Please fill in the following sections. Be specific and provide details to explain exactly what happened or what you are requesting. Feel free to attach additional pages if you need more room.
Name: ____________________________________________________
Address: ____________________________________________________
Contact Number(s) (telephone, TTY, pager): ______________________
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What is the State program, service, or activity that is the subject of your grievance or your request (for example, participating in a program or attending a public meeting)"
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Describe what happened (date, time, place, people involved, and why you believe the incident was discriminatory):
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What actions have you already taken to try to resolve this grievance"
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How would you like the State to resolve your grievance so that you may participate in the program, service, or activity without discrimination" Please list any alternatives, and let us know which you prefer. Potential solutions could include changes to policies, practices, or procedures; removing architectural, communication, or transportation barriers; and providing auxiliary aids and services.
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Please be advised that, in order to evaluate this grievance, the State may need to inquire as to the nature of your disability. If this information is provided to the State, it will be maintained in a confidential manner.
Please sign and date this form:
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Signature Date
Please give this form to the State employee running the program, or you may send it to: State Accessibility Coordinator, 150 State House Station, Augusta, ME 04333-0150.
Phone: (207) 623-7950 (voice), (888) 577-6690 (TTY), Fax: (207) 287-5292.
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For State employee use only:
Received by: _______________________________________________ Date: _____________________
C.M.R. 12, 168, ch. 50, att. 1