Columbia Basin College
2600 N. 20
th
Ave.
Pasco, WA 99301
Formal Student Complaint Process Form
The purpose of
the CBC student complaint process is to establish a clear process wher
eby a student may express
dissatisfaction with the performance or action of a College employee that the student believes to be a violation
of student rights under WAC 132S-90-010 and/or inconsistent with College policy. It is the belief and practice
of CBC that the best way for individuals to address concerns or complaints is in an informal, direct manner.
Students are encouraged to meet with the faculty or staff member and attempt to resolve the problem informally.
If the student is dissatisfied with the outcome of the informal process or did not engage in the informal process,
the student may proceed with a formal written complaint utilizing this form no later than 10 calendar days into
the following quarter after the event that serves as the basis for the complaint occurred.
CBC’s Student Complaints process can be found at www.columbiabasin.edu/studentcomplaint
. *(See
exceptions to Student Complaint Process).
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October 2019
Student Complainant Information
Name:
SID:
Address:
City
State:
Zip Code:
Email:
Phone:
I am filing a formal
Faculty
Staff Member
student complaint against (please select one)
Faculty/Staff Member Name:
The issue that serves as the basis for the complaint occurred during:
Year:
Quarter:
Fall
Spring
I am appealing the supervising administrator’s decision (Attach written appeal)
Columbia Basin College
2600 N. 20
th
Ave.
Pasco, WA 99301
Complaint Statement:
Please provide sufficient details about your complaint and attempts you have made to resolve the issue at the
information level (if applicable). Additionally, provide any suggestions or changes that will resolve/alleviate
your complaint. Refer in this section to the supporting documentation you will attach for context. (Attach
additional pages if necessary).
Student Acknowledgement
By signing this complaint, I certify the information I am providing and any supporting documentation is true and
accurate to the best of my knowledge. I understand that if this complaint and any documentation that I submit is
incomplete, it may be necessary to resubmit this form and all relevant document(s) for the complaint to be
processed.
____________________________________________
____________ Date:
Signature
Submission of falsified information or misrepresentations of substantive fact are a violation of the CBC Student Code of Conduct (WAC
132S-100-230) and may be cause for disciplinary action.
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October 2019
Columbia Basin College
2600 N. 20
th
Ave.
Pasco, WA 99301
For Official College Use Only Do not write below
Student Complaint No: ____________________
(e.g., 2019-SC-XXX)
A. Name of Supervising Administrator Response to Informal Student
Complaint
Date:
B. Supervising Administrator Intake and Assessment: The supervising administrator assesses the formal
complaint and makes a determination of whether the complaint is appropriate for further consideration.
Date of receipt of formal complaint:
Date of Supervising Administrator Determination Notification:
(Notify the student in writing no later than fifteen (15) calendar days after receipt of the formal complaint.)
(The formal complaint is terminated and may only be considered further by appeal to the appropriate vice
president or designee.)
The student complaint is not appropriate for further consideration for the following reasons
The student complaint is appropriate for further consideration.
(
Attach response to the student complaint to this form.)
C. Supervising Administrators Response: The supervising administrator will provide a copy of the form to,
consult with, and involve the faculty or staff member
as appropriate for any information or supporting
documentation addressing the formal complaint. If a meeting is held with the student complainant
, the
supervising administrator will make best efforts within the timeframe to include the faculty or staff member as
appropriate.
The student and faculty or staff member will receive a decision from the appropriate supervising administrator
within fifteen (15) calendar days after submitting the formal complaint. Attach response to the student and
faculty or staff member to this form.
Date of Meeting (if applicable):
Date of Supervising Administrators Response:
D. Appeal of Supervising Administrator Decision: If the complaint is not resolved to the student or faculty or
staff member’s satisfaction, it may be appealed to the appropriate vice president or designee. The vice
president’s decision will be made no later than fifteen (15) calendar days from receiving the appeal. Attach
response from the vice president to this form.
Date of Student or Faculty or Staff Member Filed Appeal to Vice President:
Date of Vice President’s Response:
E. Appeal of Vice President Decision: Appeal of the vice president’s decision may be made to the President
within ten (10) calendar days of the vice president’s decision only if additional evidence is provided. The final
decision of the President will be made no later than ten (10) calendar days from receiving the appeal. Attach
response from the President to this form.
Date of Student or Faculty or Staff Member Filed Appeal to President
Date of President Response:
F. Location of Student Complaint File:
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October 2019
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