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VCPN Grievances form
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Email
*
Your email
DATE
*
MM
/
DD
/
YYYY
Student id/Employee id
*
Your answer
Student/ Employee Name
*
Your answer
Mobile Number
*
Your answer
Basis of Complaint
*
Harassment
Discrimination
Unfair action/ Violation of Rights
Grievance is filed Under
*
Harassment and Non-Discrimination policy
Staff/Admin General Grievance policy
Preferred Method to Contact you
*
Your answer
1. What was the date of occurrence and what specific behavior, condition, or violation of policy or procedure occurred which you consider discriminatory, harassing or unfair / violated your rights?
Your answer
2. How have you been adversely affected by this situation?
Your answer
3. What specific action have you taken to follow the guidelines for informal resolution as outlined in the Grievance Procedures for Discrimination and Harassment or the Staff and Administrative Grievance Policy? What has been the outcome of these effort?
Your answer
4. What specific remedy do you request?
Your answer
A copy of your responses will be emailed to the address you provided.
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