ࡱ> IKHa bjbjڥڥ 4.R\R\VVVVVjjjj,j)hdX)Z)Z)Z)Z)Z)Z)$A+-H~)V~)VV):VVX)X)P'))To+R'D))0)'?.}?.()?.V)@~)~)#)?.> : Appendix A Case #: ____________(To Be Assigned by GRP) Grievance Filing Form Date of Filing this Form: __________________ Name: _______________________________ Contact Information (address, phone, email): Instructions for Questions Associated with Roman Numeral I - II: The Collected Rules and Regulations list three categories of grievances and these are listed below in Italics (see I, II, and III). Check the box(es) associated with the category or categories of the grievance you are filing. For each relevant category, answer the questions that follow by attaching a separate word document or inserting pages at the end of this document. Please number your responses in accordance with the numbering system employed below (e.g. I-a; III-b, etc.).  FORMCHECKBOX  I. There has been a violation, a misinterpretation, an arbitrary or discriminatory application of written òȾòƵ rule, policy, regulation, or procedure which applies personally to the faculty member, notwithstanding that it may apply to others within or without the grievant's unit, relating to the privileges, responsibilities, or terms and conditions of employment as a member of the faculty. List the specific written òȾòƵ rule, policy, regulation or procedure that was violated or misinterpreted. Either cite the specific Collected Rules and Regulations number or attach relevant policies (e.g., department bylaws). If there is more than one alleged violation, list each separately. For each alleged violation, list the date of occurrence of the grieved act. Please note that the grievant must file the grievance within one hundred and eighty (180) calendar days after the grievant knew, or reasonably should have known, of the occurrence of the event or omission out of which the grievance has arisen. In situations where the grievance arises out of a series of events or omissions, the filing period shall be measured from the last event or omission in the series. For each alleged violation, describe the grieved act. Include in your description the harm that you perceive resulted and the remedy requested. The description of each grieved act is limited to three double-spaced pages (Times New Roman, 12 point).  FORMCHECKBOX  II. There has been an infringement on the academic freedom of the faculty member. (For information on academic freedom, see the Collected Rules and Regulations, Section 310.010). List the date of occurrence of the grieved act. Please note that the grievant must file the grievance within one hundred and eighty (180) calendar days after the grievant knew, or reasonably should have known, of the occurrence of the event or omission out of which the grievance has arisen. In situations where the grievance arises out of a series of events or omissions, the filing period shall be measured from the last event or omission in the series. Describe the grieved act. Include in your description the harm that you perceive resulted and the remedy requested. The description of each grieved act is limited to three double-spaced pages (Times New Roman, 12 point) Instructions for Roman Numeral III - VIII: Answer the questions that follow by attaching a separate word document or inserting pages at the end of this document. Please number your responses in accordance with the numbering system employed below (e.g. IV, V, etc.). Please specify in detail any attempts made for informal resolution. The description of such attempts is limited to one double-spaced page (Times New Roman, 12 point). Please note the grievant must demonstrate that s/he attempted to informally resolve the complaint before filing the grievance. If you have any relevant evidence/attachments that you would like the Grievance Resolution Panel (GRP) to consider, please include them. You must refer to any attachments in your replies to the questions above so that the relevance of each attachment is clear. If desired, please list any additional sources of information, including persons with knowledge. Please specify the type of information available through these additional sources and the relevance of this information to the alleged violations. The grievant may also request that the GRP gather any additional relevant evidence that the grievant believes exists and that is not in the grievants possession or to which the grievant does not have access. Taking into account considerations of FERPA, HIPAA, attorney/client privilege and impact on any party or university entity, the GRP will make reasonable attempts to obtain information that it deems relevant and central to the grieved matter(s). Please list any such information and its relevance to the alleged violations. Have you filed a lawsuit related to the substantive content of the grievance? PLEASE NOTE THAT INCOMPLETE FILING FORMS OR FILING FORMS THAT DO NOT COMPLY WITH THE DIRECTIONS ABOVE WILL BE RETURNED. 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