BOSSIER PARISH COMMUNITY COLLEGE
Student Complaint Form
Date:
Student Information:
Name:
Student ID:
Address:
City: State: Zip Code:
Phone: (day/evening)
E-Mail:
Complaint being filed against: (complete all sections that are appropriate)
Name(s):
Department(s):
Date(s), time(s), and location(s) of incident:
Description of each incident: (please provide statements of fact and nature of the complaint and use an
additional sheet of paper if necessary)
Name(s) of anyone else present during each incident:
How have you attempted to resolve the situation?
What specific actions do you desire to resolve this complaint?
Student Signature: Date:
Date Received: By Office:
Student Services Revised: May 2016
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