HCTL LOCAL LEAGUE GRIEVANCE AND APPEAL FORM

PLEASE COMPLETE ALL INFORMATION.

Grievance/Appeal filed by:

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Name/Address                                                   Level                           Date/Time Filed

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Home Phone Number Office Phone Number Mobile Phone Number Fax Number

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Email address(es) Team Name                Signature

(Grievances Only) Grievance Against:

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Grievance Against Level                   Team Name

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Type - Conduct, Rules, NTRP, Eligibility, etc. Location of Match Date/Time of Incident

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Position Played Names of Other Individuals Involved

Description of Grievance or Basis for Appeal of Grievance Committee Decision: (Continue on next page or on additional sheets if necessary.)

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Received By                               Date/Time                    Committee Members (3)

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