STUDENT CONDUCT, RIGHTS, AND RESPONSIBILITIES
REQUEST FOR A FORMAL STUDENT GRIEVANCE HEARING
Name Date
Address Phone
Student ID # Class Level
Student’s Major
Department in Which Complaint Arose
Semester in Which Complaint Arose
Respondent (Grievance Against)
Course Name Course #
Members of the University Community Involved in Attempting an Informal Settlement:
Referred By
Nature Of Grievance
Remedy Sought
Please attach any supporting documentation or email to scrr@csuchico.edu
I certify that I attempted to resolve this matter informally:
Signature Date
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signature
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