Grievance FormCommittee on Privilege and Tenure

Page 1

GRIEVANCE FORM

Committee on Privilege and Tenure

Academic Senate Santa Cruz Division

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

Thepurpose of this form is to initiate the grievance process and assist the Committee on Privilege and Tenure in determining prima facie in your case.

Beforefiling a grievance, faculty should consult Senate Bylaw 335 to review the relevant policy and procedure. We also strongly encourage you to meet with a P&T Grievance Advisor. A list of P&T Grievance Advisors is available at:

Instructions:A faculty member who decides to file grievance with the Committee on Privilege and Tenure should complete the following form. outlining the main points at issue and taking care to give specific and concise answers. The Committee may make a determination ofprima faciethat faculty rights and/or privileges may have been violated based solely on the form submitted by the grievant. Upon determination, the committee may conduct a preliminary review as per Senate Bylaw 335.

Please forward the completed form and supporting documentation to:P&T Chairc/o Committee Analyst Matthew Mednick at .

For assistance, pleasecontact a P&T Grievance Advisor, or Committee analyst Matthew Mednick at (831) 459-5209 or .

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

PLEASE COMPLETE THE FOLLOWING INFORMATION:

Grievant Information:

Name/ Title

Department Division

Campus Mail Stop and Telephone Number

E-mail Address

If you have separated from the university, please list your home address and telephone number:

Address, City, State, Zip Code

Telephone Number E-mail Address

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

Completethe necessary information on the followingpage titled “Explanation of Request for Formal Grievance Review.” Sign below and emailyour grievance review request to the P&T Chair, as noted above.

Certification of the Grievant: I hereby submit a formal grievance to the Committee on Priveliege and Tenure. I certify that the statements here and any attached documents are true to the best of my knowledge and belief.

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

SIGNATURE

GrievantDate

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

Attach additional pages if necessary.

Grievance FormCommittee on Privilege and Tenure

Page 1

EXPLANATION of REQUEST for FORMAL GRIEVANCE REVIEW
1 / Please describe the matter being grieved.
2 / What rights and privileges do you assert have been violated?
3 / Specifically what evidence supports this grievance?
4 / Who is involved?
5 / Describe any attempts to achieve informal resolution. Who did you contact? Please indicate date(s) and include supporting documentation if any.
6 / What remedies are you seeking?
7 / Attach supporting documents/exhibits to demonstrate the assertions made.
8 / Preliminary list of witnesses. (Witness list is not required. If adding, please include: Relevance to the case and what they will testify about).
9 / Do you have any additional comments? (Grievant may attach a brief narrative of no more than two pages in length.)

Polices and procedures can be found at the following site:

UC Santa Cruz Academic Senate, Privilege and Tenure (P&T) page:

Attach additional pages if necessary.