APPENDIX C

Name of Appellant________________________________

Department______________________________________

College_________________________________________

1. Notification of Negative Vice Presidential Decision Received

(Date)

2. Type of Negative Decision (check appropriate type(s)):

__11.01 On tenure

__11.02 On promotion

__11.03 On nonrenewal

__11.04 On termination of a term appointment

__11.05 On termination of a tenured faculty member

3. Grounds for Complaint (check all that apply):

__11.21, __11.22, __11.23, __11.24, __11.25

4. In reasonable detail, the alleged facts which support those grounds for complaint:

5. Relief sought:

_________________________             ________________________________
Signature of Appellant                          Signature of United Faculty Representative

__________                                            ___________
Date Signed                                             Date Signed