Provost & Academic V.P. Western Illinois University 1 University Circle 211 Sherman Hall Macomb, Illinois 61455 Phone: 309/298-1066 E-mail: PS-Brown@wiu.edu

WIU/UPI Agreement 2001-2005

Appendix E: Western Illinois University
UPI Local 4100
Notice of Intent to Arbitrate

Grievance No.:               Date

The UPI Local 4100 hereby gives notice of its intent to proceed to arbitration with the decision issued by the Step Two Hearing Panel, dated:
and
received by the Union on:

In the grievance of:

Name of Grievant:

of Western Illinois University.

This notice was filed with the Academic Vice President's office on:
by (check one): [ ] Certified registered mail, return receipt requested, or [ ] Personal delivery.

Signature of Union President       (Month) (Day) (Year)

I hereby authorize the UPI Local 4100 to proceed to arbitration with my grievance. I hereby also authorize the Union and Western Illinois University or its representative to use, during the arbitration proceeding, copies of any materials in my personnel evaluation file and any files at any other university or college which are pertinent to this grievance and to furnish copies of same to the arbitrator.

Signature of Grievant            (Month) (Day) (Year)

Revised--Nov. 1996

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