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.
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