Fillable DEAN OF STUDENTS OFFICE Student-to- Student Grievance Form (CUNY Hostos Community College)

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DEAN OF STUDENTS OFFICE Student-to- Student Grievance Form (CUNY Hostos Community College)

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DEAN OF STUDENTS OFFICE
Student-to- Student Grievance Form
Complainant’s Name (print): _________________________________________________
Last First M.I.
Student ID No.: _________________________________________________
Address: _________________________________________________
_________________________________________________
City State Zip
Telephone: ( ) __________________________________________
Office/Department/Individual Involved: _________________________________________
Complaint Taken By: _________________________________________________
Reason for Complaint:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
NOTE: Are there other pages or documents attached? YES _____ NO _____
Complaint Resolved? YES _____ NO _____
SUGGESTIONS: _____________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
TRANSFERRED TO: _________________________________________________________________
NAME DEPT.
____________ ________________________________ _ __________________________
Date Signature of Staff Recording Complaint Complainant’s Signature
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DEAN OF STUDENTS OFFICE Student-to- Student Grievance Form (CUNY Hostos Community College)

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Completed 21 September 2020

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