When and/or where did this happen? [if applicable, may continue on page two, and/or include more pages)
Have you attempted to resolve your concern? If so, how? [if applicable, attach relevant documents]
What outcome and/or resolution are you seeking? [if applicable, attach relevant documents]
Do you wish to be contacted about this Complaint and/or Suggestion?
How do you prefer to be contacted?
Cascade | email@example.com | SSB 209 |971-722-5292
Sylvania | firstname.lastname@example.org | CC 247 | 971-722-4529
Rock Creek | email@example.com | 9 115 | 971-722-7215
Southeast | firstname.lastname@example.org | SCOM 116 | 971-722-6191
MyPCC Email Telephone Post Other
Where is your home campus?
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)
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
For PCC DOS Office Use
Updated byy KAT 9/2018