Complaint/Suggestion Form
Student Name
PCC ID
@pcc.edu
Telephone
Address
2.
When and/or where did this happen? [if applicable, may continue on page two, and/or include more pages)
3.
Have you attempted to resolve your concern? If so, how? [if applicable, attach relevant documents]
4.
What outcome and/or resolution are you seeking? [if applicable, attach relevant documents]
5.
Do you wish to be contacted about this Complaint and/or Suggestion?
No
How do you prefer to be contacted?
Cascade | dos.ca@pcc.edu | SSB 209 |971-722-5292
Sylvania | dos.sy@pcc.edu | CC 247 | 971-722-4529
Distance Learning
Rock Creek | dos.rc@pcc.edu | 9 115 | 971-722-7215
Southeast | dos.se@pcc.edu | SCOM 116 | 971-722-6191
Other
MyPCC Email Telephone Post Other
Where is your home campus?
1.
What is your Complaint and/or Suggestion? If this is related to a class, please include the term, Course ID, CRN
and Instructor's name. (use additional pages if needed)
Received by:
Date
Date
Please print or Save File As a different name and email to your campus Dean of Students office
or you may submit an Online Complaint/Suggestion Form
Yes
Referred Area
For PCC DOS Office Use
Date
MyPCC Email
Updated byy KAT 9/2018
dos.sy@pcc.edu
