The Camas Education Association Executive Board is committed to representation of CEA members in matters related to grievance, discipline, and evaluation.  To best represent our members CEA has an established confidential Executive-Level Certificated Grievance/Evaluation/Disciplinary Committee.  To provide most appropriate support, we are requesting your thorough completion of this document.

Name: ________________________________School: __________________________

Home Email:  ___________________________Cell Phone:  ______________________

  1.  Is this a request for assistance with a grievance?                                  __ Yes __ No

(If yes, skip to Section 1:  Grievance)

  1.  Is this a request for assistance with potential disciplinary matter?                  __ Yes __ No

(If yes, skip to Section 2:  Discipline)

  1.  Is this a request for assistance with evaluation?                                  __ Yes __ No

(If yes, skip to Section 3:  Evaluation)

Section  1:  Grievance

1.a.  Do you believe that there has been a violation, misinterpretation, or misapplication of the District rules, regulations, administrative directives, or policies concerning wages, hours, conditions of work, or the current negotiated contract?                         __ Yes __ No

1.b.  Please list the violated, misinterpreted, or misapplied District rule, regulation, administrative directive, policy, or CBA provision:  

1.c. Which administrator (s) do you believe has violated, misinterpreted, or misapplied this district rule, rule, administrative directive, policy, or CBA provision?

1.d.  What steps have you taken to notify this administrator of this violation, misinterpretation, or misapplication?  Be specific, and list dates:

1.e.  What contractual remedy are you seeking:

Section 2:  Discipline

2.a.  Have you been notified by an administrator that you have the right to representation in an upcoming meeting, investigation, or hearing?           __ Yes __ No

2.b.  By law, not all meetings with a supervisor grant the right to union representation.  If a supervisor mentions:  discipline, termination, employment status, or negative evaluation as the purpose for a meeting, you definitely need to have a union representative present. 

Have you had a discussion that you believe could lead to discipline, termination or adverse affect to your employment or working conditions?                         __ Yes __ No

2.c.  Which administrator(s) has caused you to believe you are in need of representation?  

2.d.  Briefly describe your situation:

2. e.  Are there currently any formal letters in your file, currently?          __ Yes __ No


Section 3

        3.a.  Are you completing a comprehensive or focused evaluation?

        ___Comprehensive                ____Focused


3.b.  Have you had any formal meetings with your supervisor in regards to your evaluation?  

                                                                         __ Yes __ No

3.c.  What is the name of your supervisor?  

3.d.  Please describe your situation

3.e.  Are you currently provisional status?                                 __ Yes __ No  

3.g.  Are you currently on an informal plan of improvement?                 __ Yes __ No

3.h.  Has the District mentioned placing you on formal probation?         __ Yes __ No  

        Have you fully disclosed al of the circumstances of your situation, to the best of your ability?  

__ Yes __ No

The Camas Education Association Executive-Level Certificated Grievance/Evaluation/Disciplinary Committee meets in confidence to discuss all member requests.  Your CEA understands our duty of fair representation, and values full and thorough examination of all member interests. CEA Members have an unfettered right to the Grievance Procedure provided in the Collective Bargaining Agreement at the internal steps of the grievance process.  The Committee may elect, via a majority vote, to not advance a grievance.  Members always retain the right to solely advance matters through the grievance process through the internal steps.  CEA retains its right, as the bargaining agent, to full involvement in the processing of any grievance, through any/all steps of the process.  The Committee will fully deliberate if a grievance has merit to advance to arbitration, in consultation with WEA-Riverside UniServ and WEA Arbitration Specialists, and will decide by majority vote.  Impacted members will be asked to submit necessary documents in advance of this deliberation and make a presentation to the Committee in advance of the vote. The decision of the Committee is final.

_______________________________ Printed Name

_______________________________  Signed Name

_____________________  Date