CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO
STUDENT NON-ACADEMIC GRIEVANCE
POLICY AND PROCEDURES
NON-ACADEMIC GRIEVANCE PROCESS FORM
Student's Name
Telephone
Street Address
City
Zip
Telephone Number
Email
Student's Statement
I am beginning the grievance process because of an action by
(University employee) which I describe below.
Student's Signature
Date
Attach extra pages if needed to fully describe and explain the following:
Describe the grievance, provide relevant dates of events of the
grievance and include the names of all parties involved. Please attach extra pages
if needed.
Describe your proposed resolution, relief or action sought.
List or describe the University documents, records or materials which
are relevant to this grievance.
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The student delivers two completed copies of this page and attachments to the Vice
President for Student Affairs, UH room 231, 909-880-5185. The office signs below for
receipt of the form.
Received by Office of Vice President, Student Affairs
Date
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(Optional) I hereby authorize student members of the Non-Academic Grievance Hearing Panel
to have access to information and materials contained in my grievance.
Student's Signature
Date
After the student has delivered a copy of the front page and attachments
to the Vice President for Student Affairs, the student begins the grievance process.
INFORMAL GRIEVANCE PROCESS RESULTS
Date submitted for employee's review:
Results of the employee's review:
Review Date
Employee's Signature
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Date submitted for review by employee, his/her supervisor, and the next level supervisor:
Results of that review:
Review Date
Next Level Supervisor's Signature
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REQUEST TO BEGIN FORMAL GRIEVANCE PROCESS
(Student) I am requesting the initiation of the formal grievance process. I am
making the irrevocable choice between (check) convening
a Hearing Committee or (check) making an
in-person appeal through each administrative level up to the relevant Vice President
Student's Signature
Date
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FORMAL GRIEVANCE PROCESS RESULTS
(To be completed by Office of the Vice President for Student Affairs)
Committee selection date:
Committee selected by:
Committee members and convener:
Hearing request denied or
approved (Cite reason if hearing is denied and inform next level supervisor):
Date of Hearing:
Committee Hearing results:
Date all parties were notified of results:
STUDENT NON-ACADEMIC GRIEVANCE POLICY AND PROCEDURES
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