Appendix E

THE CALIFORNIA STATE UNIVERSITY
GRIEVANCE PROCEDURE FORM
UNIT 4

LEVEL OF FILING DATE OF FILING Campus:__________

Level I – President ____________________________

Level II – Labor Relations, _________________________
Office of the Chancellor

GRIEVANT'S NAME CLASSIFICATION CAMPUS TELEPHONE NUMBER

Specific term of agreement alleged violated (provide Unit 4 contract provision number):

Detailed description of the grounds of the grievance (include dates, places, times, etc.):

(If more space is needed, additional sheets may be attached.)
Proposed remedy:

Grievant’s signature:

Grievant’s address:

Name of representative:

Representative’s address and telephone number:

Response
Level I /_/ Level II /_/
Signature:_______________ Title:_______________ Date:_______________

Please provide one copy of each grievance filing or response to: a) employee; b) Employer (level of filing); c) Labor
Relations, Office of the Chancellor, 401 Golden Shore, Long Beach, CA 90802; d) employee’s representative.

(Revised 2005)