Complaint Form
(Procedure 4.401)
When a student believes that a condition exists that is in violation of his or her rights, college
policies, rules, standards, and procedures, he or she has the right to file a complaint. Students’
grievances /complaints are handled in accordance with Administrative Procedure 4.401, which can
be found on the college’s website at
http://elgin.edu/aboutus.aspx?id=278&terms=Appeal%20for%20Complaint%20Procedure.
The information you provide will be used in an effort to resolve your complaint and will be shared with the
appropriate college personnel.
Complaints MUST be initiated within 20 school days of the occurrence of the incident.
Prior to completing this form, SAVE the complaint form as a file titled, "Your Last Name-
Complaint". Open up the saved file and fill out the form completely. E-mail that completed complaint
form back to the Dean of Student Services and Development at DeanofStudentServices@elgin.edu as an
attachment, or print, sign and deliver back to the Office of the Dean of Student Services and Development,
Room B105.13.
Please check the appropriate designation: Student: ECC Staff:
First Name: Last Name:
Student ID #: Cell Phone Number:
Other Phone Number:
Street Address: PO Box or Unit #:
City: State: Zip Code:
Date of Incident: Date Complaint Filed:
Description of Complaint
(Please give specific details)
Choose a Complaint Category from dropdown menu:
Nature of complaint:
(Discrimination and sexual harassment complaints will be referred to the EEO/AA Officer)
E-mail Address:
