GEORGIA NORTHWESTERN TECHNICAL COLLEGE
STUDENT CODE OF CONDUCT COMPLAINT FORM
Any administrative official, faculty member, student, or security officer may file a complaint with the Student
Disciplinary O fficer or his/ her designee against any student for a violation of the Student Code of Conduct. The
individual(s) initiating the action must complete a Student Code of Conduct Complaint Form, and forward it directly to
the Student Disciplinary Officer, Stuart Phillips.
Date:
Student Name: Student ID#:
Telephone: Email:
Program: Department:
Code Violation(s) (refer to Student Code of Conduct located in GNTC’s Student Handbook:
Explanation of Complaint:
Witness(es) :
Have you discussed the specific behaviors that are said to be in violation of the Student Code of Conduct?
□ Yes □ No
Have you attempted to resolve the issue in good faith? □ Yes □ No If yes, please describe the resolution:
Name: Telephone:
Signature: Email:
(Reference: Technical College System of Georgia Disciplinary Policy and Procedure)
