APPENDIX D

REQUEST FOR REVIEW OF STEP 1 DECISION

GRIEVANT STEP 1 GRIEVANCE REPRESENTATIVE

NAME:_____________________ NAME:____________________________

UNIVERSITY:_______________ MAILING ADDRESS:

COLLEGE:__________________ ____________________________

DEPT______________________ ____________________________

OFFICE PHONE:_____________ OFFICE PHONE:______________

DATE OF STEP 1 DECISION: _______________________________

Article(s) and Sections(s) of Agreement allegedly violated (as specified at Step 1):

____________________________________________________________________

I hereby request that the Chancellor or representative review the attached decision made in connection with the attached grievance because:

Remedy Sought (if initial filing is at Step 2):

____________________________________________________________________

Grievant's representative received the decision on _______________________.

Grievant filed this request for review with the Chancellor’s Office on _______________, by (check one): mail (certified or registered, restricted delivery,

return receipt requested) _____; personal delivery _____; other (specify) __________.

DATE OF RECEIPT BY CHANCELLOR'S OFFICE:__________________________

Signature of Grievant

I am represented in this grievance by (check one - representative should sign on appropriate line):

______ UFF ________________________________________

______ Legal Counsel ________________________________________

______ Myself ________________________________________

(See page 2 for additional requirements)

A copy of the following documents must be attached to this Request at the time of its filing with the Chancellor or representative:

1. Appendix C - Original grievance form filed with the University.

2. Step 1 Decision, if issued by University.

3. All attachments to Step 1 Decision, as required in Section 20.8, Grievance Procedure.

This request should be sent to:

OFFICE OF HUMAN RESOURCES

BOARD OF REGENTS, STATE UNIVERSITY SYSTEM OF FLORIDA

325 W. Gaines St., Rm. 1614

Tallahassee, Florida 32399-1950

The Step 2 decision shall be transmitted to Grievant's Step 2 Representative (if Grievant is represented by UFF, the decision will be sent to the UFF State Office) by personal delivery with written documentation of receipt or by certified mail, return receipt requested. Copies of this decision shall be sent to Grievant and the President's Representative for Contract Administration, and to the UFF if grievant elected self-representation or representation by legal counsel.