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FORMAL GRIEVANCE/COMPLAINT FORM
Name of Student: _________________________________ Student I.D.#: ___________________________
Reason not satisfied with outcome of informal process:
Yes, I want to move to the Formal Grievance Process.
Student Signature: ___________________________________________ Date: ________________________
To be by completed by VPSA.
Additional Information, Witnesses, etc.:
New Outcome:
Decision Letter with Opportunity to Appeal Mailed: (Date) __________________________
Vice President for Student Affairs Signature: __________________________________________________________
Date Appeal Received: __________________________
Appeal Filed: Yes
No
As set forth in full in the Student Handbook/Course Catalog, Southern Crescent Technical College is an Equal
Opportunity Institution and does not discriminate on the basis of race, color, national origin, sex, age or disability.
Created: 10/23/2018
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