Grievance Form - New Mexico Highlands University

Date:*

Your Name:*

Your Email:*

ID Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone:

Work Phone:

Name of person whose conduct gives rise to this grievance:*

That Person's Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Their Work Phone:

Their Home Phone:

University policy or procedure that was violated:*

First date violation took place:*

Most recent date violation took place:*

Describe in detail the conduct giving rise to the grievance, including the facts, circumstances, and any other pertinent information:*

Explain why you believe that the conduct violated university policy or procedure:*

Identify any witnesses having information pertinent to your grievance, including the name, address and work/home telephone number of each witness, if possible:*

State the action requested to resolve grievance:*

I affirm all information on this form is correct to the best of my knowledge.*

Yes

I consent to my submitted data being collected and stored*

Yes