DELGADO COMMUNITY COLLEGE
Respondent's Problem Solving Response Form
Date: ________________________________
To: ________________________________
Address: ________________________________
________________________________
From: ________________________________ ________________________________
Name College Title
________________________________
Office Phone Number
_______________________________ (name of employee) has requested a meeting to discuss the attached alleged problem (see attached copy of Notification of Problem Form 2534/001) and has identified you as a respondent. The employee has requested I serve as the employee’s Mediator in accordance with the College’s Faculty Grievance Procedures. I am the employee’s (check one):
____ Immediate Supervisor ____ Intermediate Supervisor ____ Vice Chancellor for Academic Affairs
To provide me with your response to these allegations, complete the following and bring it with you to the meeting on _______________________ (date) at which time we will discuss the problem. Additional pages and/or documentation may be attached, if needed.
* * * * * * * * * * * * * * * * * To Be Completed by Respondent * * * * * * * * * * * * * * * *
Your Response to the Employee's Identification of the Problem:
Your Response to the Employee's Definition of College Policy and Procedures That Were Allegedly Violated or Applied in an Inequitable or Discriminatory Fashion:
Your Response to the Employee's Representation of the Facts:
_____________________________ _____________________
Respondent's Signature Date
(Copy of Form 2534/001 must be attached.)
Form 2534/002 (5/17)
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