Student Name:
ID#:
STUDENT’S WRITTEN DESCRIPTION OF THE FORMAL COMPLAINT
Please carefully answer all of the following questions since your responses will determine the disposition of your
complaint. Attach additional written statements to this form.
What is the date on which you will submit your written complaint to the Campus Associate Dean of Academic
Affairs or Associate Dean of Nursing?
Clearly describe your concerns.
Clearly describe the events that led to your concerns.
Clearly state what you seek as a resolution to your concerns.
Clearly state why you feel you are justified to get the desired resolution.
Associate Dean’s Signature____________________________
Date Rec.: _______________
WHAT HAPPENS NEXT:
1) The faculty member against whom the complaint has been filed will be given an opportunity to respond in writing.
2) Based on your submitted complaint and other relevant material, the Associate Dean of Academic Affairs or Associate Dean of
Nursing may make a decision on the matter or refer the complaint to a campus Academic Complaint Appeal Committee for a
recommended resolution. If that is the case:
a. The campus Academic Complaint Appeal Committee will be convened within two weeks of the filed complaint.
b. The campus Academic Complaint Appeal Committee shall forward its written recommendation within 72 hours of the
close of
its deliberations to the campus Associate Dean of Academic
Affairs or Associate Dean of Nursing.
c. The campus Associate Dean of Academic Affairs or Associate Dean of Nursing may accept, reject, or modify the
recommendation of the campus Academic Complaint Appeal Committee.
3) The decision of the appropriate Associate Dean of Academic Affairs or Associate Dean of Nursing is forwarded to you by
certified mail.
4) You have the right to appeal the decision of the Associate Dean of Academic
Affairs or Associate
Dean of Nursing.
5) If you choose to appeal
the decision of the Associate Dean of Academic Affairs or Associate Dean of Nursing, you must do so
within 7 days of the receipt of the certified letter.
6) If you choose to appeal
the decision of the Associate Dean of Academic Affairs or Associate Dean of Nursing, you must do so
in written form to the campus
Dean of Academic Affairs.
7) The decision of the campus Dean of Academic Affairs is final.
AL:10.23.19
Page 2 of 2
click to sign
signature
click to edit