APPENDIX D

Name of Appellant:_________________________________

Department:_______________________________________

College:__________________________________________

1. Disposition of the appeal by the Vice President and Provost 
(check and complete a. or b.):

__a. was received on_________________________ (Date).
                                          

__b. was not received within forty-five (45) days of the conference on_____________________ (Date).

2. I, ____________________________, do (do not) hereby appeal the disposition 
of my appeal by the Vice President and Provost, as referred to in Section 1 above, 
to an arbitrator.

___________________________________
(Signature of Appellant) (Date Signed)

3. I,_______________________________ (Name of United Faculty Representative), 
the undersigned duly authorized representative of United Faculty, do hereby 
endorse the intent to appeal to an arbitrator as found in Section 2 above.

________________________________________________
(Signature of United Faculty Representative) (Date Signed)