Grievance Form

Use this form to file a formal grievance through the USFFA.

Download this file as a Word Document HERE.

University of San Francisco

Grievance Form

Level of Filing (check relevant step)

Step 1  _____    Step 2   _______

Date   _______________________________

Name of College   ______________________

Answer all questions below completely. Attach additional sheets if necessary.

l. What provision(s) of the Agreement were violated?

2. 0n what date did the alleged contract violation occur?

3. Provide a detailed description of the grounds of the grievance including alleged contract violation, how the grievant was harmed and all relevant information necessary for a complete understanding.

4. Was this grievance discussed with the Dean/Librarian?

Yes   ____    no  ____      date   _______________________________

5. State the proposed remedy as concisely as possible.

I understand that a grievance must be clearly and concisely stated on this form. The contents of this form are accurate and true. Grievance forms not properly completed, as set forth in the grievance article, may not be accepted by the University.

Grievant’s signature    ______________________________

Date of submission    ________________________________

Place of submission   ________________________________

Representative’s signature   __________________________