Dillard University
Division of Enrollment Management
Grievance Form
Students are encouraged to resolve grievances (or complaints) at the appropriate level of
dispute; however, should this approach fail or be inappropriate, students may submit
written grievance through the form below. All pertinent information should be listed
including date, time, location, parties involved, witnesses, any attempts to resolve
grievances and desired resolution.
Grievances must be made in writing and submitted through this form. Emails are
acceptable and will accompany this document for record keeping purposes. Once
received, the grievance will be forwarded to the appropriate Director or the Vice
President for review, and the filer will receive an e-mailed response within five business
days indicating a resolution or a status.
If the grievance is not resolved by the staff person, the student should appeal to the
director of the person, against whom the grievance is being made. If the grievance is
resolved with this person, no further action is needed but, a record of the grievance and
its resolution should be sent to the next lines of authority for record keeping. If the
grievance is still not resolved, the same procedure may be used to appeal to the next line
of authority. If the matter remains unresolved, the grievance may be appealed to the
divisional Vice President, whose decision is final. At each line of authority, the form is
signed and moved to the next level by all involved in the grievance process.
This form is to be used for all instances, whether by a person or as a result of a situation
or event that occurs by a staff member or an event within the Division of Enrollment
Management (Evening Program, Financial Aid & Scholarships, Records and
Registration, and Recruitment, Admissions and Programming).
Date and time of grievance _________
Student Name ________________________________________ SID ______________
Classification ___________________
Phone __________________________ Email ______________________________
Please select the office(s) in which the issue occurred (please check all that apply):
Evening Program Financial Aid and Scholarships
Records and Registration Recruitment, Admissions and Programming
Please indicate the name of the person (or office) to which the grievance is being made.
Write a brief statement explaining the nature of your grievance, including any prior actions
(use additional sheets if necessary):
Attach any documents that support your grievance (list them here and attach copies).
If there were witnesses, please list below.
What is the desired resolution you are seeking for this grievance?
Your Signature: ____________________________________ Date: _________________
First Respondent’s Name: ___________________________________________________
Title: ___________________________________________________________________
Email: ______________________________Phone: ______________________________
Brief Description of Action Taken:
Vice President’s Name: _____________________________________________________
(only if needed)
Title: ___________________________________________________________________
Email: ______________________________Phone: ______________________________
Brief Description of Action Taken:
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