For the purposes of this assignment, you are a union steward elected by the members of the student solidatity union to advocate for them.

Grievance NumberOFFICIAL UNION GRIEVANCE FORM

Name of Employer___ _ _ _ Phone ( ),_ ___ _

Include Area Code)

Name of Local Union _ Phone (

Statement of Grievance: List what happened, where, when , why. Also, any contract violation.

Adjustment or Settlement Requested: (To be completed by Union)

I authorize the Union to act for me in the disposition of this grievance and authorize the employer to release any information requested by the Union regarding this grievance.

x _ _ x_ _

Signature of Gr evant Signature of Local Union Representative Date

Name of Employer Representative who handled the grievance at the following steps:

Verbal Step_ _ 1st Written Step 2nd Written Step __ _ Employer's Answer to 1st Written Step: if grievance is denied, give reasons and proofs.

Employer's Answer to 2nd Written Step:

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NOTICE TO LOCAL UNION - Make 3 Copies: (1) Employer, (2) Union, (3) Local Union. Be sure to send all proofs and evidence to the Union office along with Grievance.

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