VCPN Grievances form
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Email *
DATE *
MM
/
DD
/
YYYY
Student id/Employee id *
Student/ Employee Name *
Mobile Number *
Basis of Complaint *
Grievance is filed Under *
Preferred Method to Contact you *
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?
2. How have you been adversely affected by this situation?
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?
4. What specific remedy do you request?
A copy of your responses will be emailed to the address you provided.
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