ࡱ> U Rp5bjbjnn?:aaY_ 228:4nl5BHD9D9D9AAAAAAA$}D3G>A9D98|D9D9D9A22A;;;D92A;D9A;;:@,6@pѓ6:R0@ |AB05B:@RqGZ:qG@qG@D9D9;D9D9D9D9D9AA*;vD9D9D95BD9D9D9D9qGD9D9D9D9D9D9D9D9D9 V :  Chang Gung University Student Grievance Form NameCollegeDepartment or Graduate Institute (Student Self-Governing Organization)YearStudent NumberBiological SexComplaining Student (Student Governing Organization) ! Office of President (Review Committee)Is the Special Education Student Status Certified? %No %Yes, the categoryEmail AddressMailing AddressMobile Phone NumberOriginal Respondent Unit for Punishment and MeasuresFacts for Grievance(The name, content and delivery date of the document containing the 91ès punishment, administrative sanction, measures or decisions)Reasons for Grievance(List reasons if the 91è has violated the law, and caused damage to rights and interests when making the relevant punishment.) (This is a self-extending table)Hopes for Remedy (Suggest specific and feasible ways. Example: revocation of the original punishment)Attachment(Attach documents and evidence. Please bind them after the form) 1. A copy of the original administrative sanction (punishment, measures, or decision). 2. Supporting evidence for the case (attachment). 3. Letter of appointment (As per Article 5 in these Regulations.) 4. For special education students, please attach a copy of an identification certificate that is within the valid period. 5. For student self-governing organizations, please attach a copy of the meeting minutes for grievance claim and copies of relevant procedural documents. Claimants Signature: yyyy-mm-dd \^`fhvx      , . 0 B ǼznzcVKhhB*phhhB*o(phhhnHtHhB*nHphtHhhB*nHphtHh/h>*B*PJph h>qhh>qhB*phhB*phhB*o(phh>qhCJ aJ hB*CJ aJ phhB*CJ aJ o(ph h%hB*CJ aJ o(phjhUmHnHu^hx  . 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    2 <1R    2 O1R  'R---  2 3R?  2 3RNo   2 3R   2 3R    2 ER?   2 ERY  #2 ERes, the category  2 E\R  'R$---  2 3$RE  2 3$Rmail   2 E$RAddress   2 E$R  'R%---  2 <y%R  '- @ !/-- @ !g1- - @ !-- @ !L- - @ !-- @ !- - @ !-- @ !1- - @ !-- @ !K- - @ !$-- @ !K%- - @ !p-- @ !\q- - @ !- - @ !8/- - @ !8- - @ !8- - @ !8$- - @ !8- S1---  2 lM1SM 2 l[1Sailing  2 l{1S    2 ~K1SA  2 ~V1Sddress  2 ~~1S  'S---  2 u8S  '$S---  2 bS$M 2 bS$obile   2 uS$Phone   2 uS$   2 S$Number    2 S$  'S%---  2 by%S  '- @ !R/-- @ !gR1- - @ !R-- @ !LR- - @ !R-- @ !R- - @ !R-- @ !KR- - @ !R$-- @ !R%- - @ !R- - @ !8S/- - @ !8S- - @ !8S- - @ !8S$- - @ !8S- 1--- 2 L 1Original    2 @ 1Respondent   2 L 1Unit for   2 A 1Punishment     2 9 1and Measures  2 1  '---  2   '- @ !/-- @ !g1-- @ !g1- - @ !-- @ !-- @ !=-- @ !=- - @ !-- @ !-- @ !I-- @ !I- - @ !$-- @ !$-- @ !'-- @ !'- - @ !- - @ !]/- - @ !]- - @ !]- >1---  2 I1>F  2 R 1>acts for   2 &F 1>Grievance   2 &1>  '>---  2 >( =2 !>The name, content and delivery da    &2 }>te of the document   2 >  2  >containing  2 7>  2 @ >the 91ès   d2 ;>punishment, administrative sanction, measures or decisions)       2 >  '- @ !/-- @ !g1- - @ !-- @ !4- - @ !- - @ !R/- - @ !R- - @ !R- ?1---  2 ?1?R  2 I 1?easons for   2 F 1?Grievance   2 1?  '?--- 2 PR?(List reasons if the 91è has violated the law, and caused damage to rights and      R2 e/?interests when making the relevant punishment.)      2 e?    2 z?    2 ?    2 ?    2 ?   "2 ?(This is a self   2 ?- #2 ?extending table)    2 [?  '- @ !>/-- @ !g>1- - @ !>-- @ !4>- - @ !>- - @ !?/- - @ !?- - @ !?- 1--- 2 E 1Hopes for   2 K1Remedy    2 }1   2 1  '--- V2 2(Suggest specific and feasible ways. Example: revo        2 c 2 ation of   2   2   the original    2  punishment)   2   '- @ !/-- @ !g1- - @ !-- @ !4- - @ !- - @ !J/- - @ !J- - @ !J-  1---  2 }A1 A  2 }L 1 ttachment   2 }1   ' --- d2 0; (Attach documents and evidence. Please bind them after the      2 0 form   2 0: )  2 0?     2 D 1 2 D .  :2 D A copy of the original administ    Y2 Dl4 rative sanction (punishment, measures, or decision).      2 D    U2 X1 2. Supporting evidence for the case (attachment).     2 X    I2 l) 3. Letter of appointment (As per Article        2 l 5  +2 l in these Regulations.    2 l* )  2 l/    2 W 4. For special education students, please attach a copy of an identification certificat    2  e    ;2   that is within the valid period.    2 X    "2  5. For student   2  self  2   - Y2 4 governing organizations, please attach a copy of the     2 ^   2 c meeting    2  minutes   2    )2  for grievance claim    M2 Q, and copies of relevant procedural documents.   2 o    2    '- @ !/-- @ !g1- - @ !-- @ !4- - @ !- - @ ! /- - @ !/-- @ !/-- @ !g1- - @ ! - - @ !-- @ !3- - @ ! - - @ !-- @ !-  ---  2 _cC  2 jclaimant  2  cs Signature:  /2 c   2 Jc   2 _c  2 cyyyy  2 c- 2 cmm   2 c- 2 cdd  2 c  --$LLL--O- O- 8,||xssxxojjoof``ff\WW\\SNNSSLLKKLLLKKLLLKKLLLKKLLLKKLLLKKLL LKK L LLKKLLQQLLUZZUU^dd^^hmmhhqvvqqzzz     -- 'M--- [#2 VMSeal of Receipt   [%2 VMof the Grievance  sө- - - --- [#2 VMReview Committee [ 2 M  ' - -$+++--',------  2 5,F 2 < ,orm Number 2 ,G 2  ,00A000101  2 , @з- - - @з- - - - @ !5-  '- -$SyySS--- - $SyyS-- 'tY--- 2 mYtAtta  2 mYtchment   2 mYt  '"SystemG9 `N- - ccbbaa?P ՜.+,0 hp|     Title  !"#$%'()*+,-./0123456789:;<=>?@ABCDEFGHIKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F`ݓ6Data 1Table&GWordDocument?:SummaryInformation(JTmDocumentSummaryInformation8CompObjn  FMicrosoft Word 97-2003 MSWordDocWord.Document.89q