Columbia Basin College
2600 N. 20
Pasco, WA 99301
For Official College Use Only – Do not write below
Student Complaint No: ____________________
A. Name of Supervising Administrator Response to Informal Student
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
supervising administrator will make best efforts within the timeframe to include the faculty or staff member as
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: