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Statement of Grievance

[For Use with Meridian’s Formal Grievance Process Only.] 

 

This form is used to initiate a Formal Grievance Process under Meridian University’s Grievance Policy and Procedures.  

Personal Data

Name

Student Address on File

Student E-mail Address

Student ID Number

Date of First Enrollment at Meridian University

Program of Study/Degree Being Pursued

Nature of Your Grievance

Please indicate whether your grievance involves any of the following (check all that apply):

Please indicate whether your grievance involves any of the following (check all that apply):

Informal Resolution Efforts

Except where prohibited by law, students are required to attempt informal resolution prior to filing formal grievance. Please use this section to describe the reasonable, good-faith efforts made by you or any other involved parties to address the issue informally (e.g., communications, meetings, or other attempts to resolve the concern). Please also describe what was recommended at the conclusion of that process:
If informal resolution was not required or not appropriate due to applicable law or regulation, please explain:

Description of the Grievance

Date the grievance first arose or became known to you:

Using the space below, please describe your grievance in detail

Attach any documents that support or evidence your grievance

Individuals Involved

Please identify all persons involved in the conduct giving rise to your grievance (name, title, and contact information) if known:

Please identify any individuals who may have personal and direct knowledge of the facts giving rise to your grievance (witnesses), if known:

Requested Resolution

Please describe what outcome or resolution you are seeking through the formal process or describe what would resolve the Grievance to your satisfaction:

CERTIFICATION

By signing below, you certify that nothing contained in the foregoing Statement of Grievance, including any attachments thereto, is willfully false, and you further understand and acknowledge that knowingly providing any false statements in the foregoing Statement of Grievance could subject you to disciplinary action, up to and including administrative withdrawal from Meridian University and the initiation by the University of arbitration proceedings against you.

Name

Signature

Signature

Date