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APPENDIX I
GRIEVANCE FORMAT (STEP 1)*
Grievant’s Name
Campus and Department
Mailing Address Telephone
PSCFA Grievance Committee Representative
Telephone Date of Incident Being Grieved
Section(s) of Collective Bargaining Agreement Related to Grievance:
Specific Description of Violation/Misapplication of Above Section(s) (including resultant harm
to grievant)
Specific Remedy Sought by Grievant:
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Step One Response Due Date (14 College business days after receipt of this form)
Immediate Supervisor Response:
Signature of Grievant Date
Received by (Immediate Supervisor or designee) Date
cc: PSCFA President
Board of Trustees Contract Administrator
*This appendix may be used as a form for submission of a grievance or as a format to
follow when submitting a grievance. Attach additional pages as necessary. Please insure
that all requested information is included.
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