Name                                                  Date   

E-Mail Address       

Job Title                                             Work Phone 

Supervisor                                           Dept.

Date Grievance Occurred          

Specific Contract violation and any other applicable section:               
Article #                      Section #         

Grievance is: (State briefly the general nature of the complaint and the facts giving rise to it.  Use reverse side of form, if needed.)                                                               

Corrective Action Requested:     

Grievance Filing Date                 

Signature of Union Representative   

Signature of Grievance Committee Member     

Please complete and return to  an Executive Board Member via email. Please see the "contact us" page for a list of our executive Board Members