Schedule F

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SCHEDULE “F”

GRIEVANCE FORM

TO BE COMPLETED BY GRIEVANT OR HIS/HER REPRESENTATIVE

Name: Title:

Work Location: Supervisor:

State all provisions of Agreement involved:

Article(s): Section(s):


Date of Occurrence:

Statement of Facts (use additional sheets if necessary):

Remedy Sought:

Date Submitted Aggrieved Employee

Date Submitted Program Supervisor


STAGE 1 – DECISION

Date Grievance Received:

Decision (use additional sheets if necessary):


Date Decision Issued Supervisor’s Signature


STAGE 2 – APPEAL

To be submitted to the District Superintendent within ten (10) school days of receipt of Stage 1 – Decision or date Stage 1 – Decision was due, whichever is earlier.

The decision at Stage 1 of the grievance is unsatisfactory.

Short statement of the grievance:

State all provisions of Agreement involved:

Article(s): Section(s):


Remedy Sought:

Date Submitted Aggrieved Employee


STAGE 2 – DECISION

Date Appeal Received:

Decision (use additional sheets if necessary):


Date Decision Issued District Superintendent or Designee

STAGE 3 – APPEAL

To be submitted to the District Superintendent within ten (10) school days of receipt of Stage 2 – Decision or date Stage 2 – Decision was due, whichever is earlier.

The decision at Stage 2 of the grievance is unsatisfactory.

The following issues are unresolved:

Authorized Signature of UBTO


Date Submitted


STAGE 3 – DECISION

Date Appeal Received:

Decision (use additional sheets if necessary):


Date Decision Issued Board of Education


STAGE 4 – APPEAL

To be submitted to the District Superintendent within ten (10) school days of receipt of Stage 3 – Decision or date Stage 3 – Decision was due, whichever is earlier.

The decision at Stage 2 of the grievance is unsatisfactory.

The Ulster BOCES Teachers’ Organization demands arbitration on the following issues:


State all provisions of Agreement involved:

Article(s): Section(s):


Remedy Sought:

Authorized Signature of UBTO


Date Submitted