__________________________________________         ________________
(Name of Appellant)                                                  (Date)

________________________________________________________________
(Department, School or College)

My signature will acknowledge that I have considered the attached grievance. My response to, or action taken on, this grievance is reflected in the attached statement or letter.

__________________________________________         ________________
Chair or Coordinator                                                  (Date)

__________________________________________         ________________
Dean or Director                                                       (Date)

__________________________________________         ________________
Provost and Vice President for Academic Affairs             (Date)

Received by the Chair of the Faculty Review Committee

__________________________________________         ________________
                                                                             (Date)

Instructions: The written grievance and the transmittal letter are to be submitted by the appellant to her/his immediate supervisor who after consideration will return these papers to the appellant with a response attached.  If the grievance is not resolved at that level, the same written grievance, transmittal letter, and response of the supervisor will then be submitted by the appellant to the next higher level of administration.  After time for consideration, these papers will be returned to the appellant with that administrator’s response attached.  If a resolution is not attained at that level, such written grievance, transmittal letter, and responses will then be submitted by the appellant in a like manner to each higher level of administration up to and including the Provost and Vice President for Academic Affairs.

Each administrator will attach her/his written response to the transmittal letter, and these responses will remain with the transmittal letter at all times.  These materials will be delivered to the Faculty Review Committee only after all of the above preliminary steps have been completed.  All matters under this procedure will be handled as expeditiously as possible, i.e., no longer than ten (10) working days for the response of each administrative reviewer.  The appellant must also respond at each level within ten (10) working days.