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Aggrieved Person's Name
Aggrieved Person's Address
RE: Resolution of EEO Dispute
Dear [Aggrieved Person]:
This refers to the dispute which you first discussed with me on
[DATE] when you alleged discrimination because of [IDENTIFY BASIS
OF DISCRIMINATION] when on [IDENTIFY DATE OF ALLEGED
DISCRIMINATORY EVENT] the following occurred: [IDENTIFY
ALLEGED DISCRIMINATORY EVENT] ___________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
___________________________________________________________. The
purpose of this letter is to set out the terms of the informal
resolution.
[INSERT TERMS OF RESOLUTION] ____________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
If you believe the agency has not complied with the terms of the
informal resolution, you may, under 29 C.F.R. § 1614.504, notify
the Director of Equal Employment Opportunity in writing within 30
days of the date of the alleged violation, requesting that the
terms of the informal agreement be specifically implemented.
Alternatively, you may request that the claim be reinstated for
further processing from the point processing ceased.
The agency has signed the terms of the resolution as indicated by
the signature of the agency official. Your signature and date
below will verify your receipt of this letter and will signify your
agreement with the terms of the informal resolution of this dispute
as set out above. Enclosed is a duplicate copy of this letter.
Please date and sign the original and the copy in the spaces
provided and return the copy to me for inclusion in the counseling
file. I will send a signed copy to the agency. You may keep the
original.
Sincerely,
___________________ _____________________ _________________
EEO Counselor Agency Official Aggrieved Person
Date: Date: Date:
This page was last modified on November 8, 1999.