Informal Student Complaint Form
Anoka Technical College is an affirmative action, equal opportunity employer and educator, and a member of the Minnesota State Colleges and Universities system.
This document is available in alternative formats to individuals with disabilities by calling 763-433-1100, TTY: 7-1-1 or 800-627-3529.
1355 West Highway 10
Anoka, MN 55303
This form is used when a student would like voice their issue or concern to the college, without the
expectation of a formal action. All complaints should be filed by an individual student. Submit the form to the
Dean of Student Affairs. The Dean will provide a copy of the complaint to the supervisor of the employee
involved in the complaint, which will be shared with the employee.
Name: Student ID:
Email Address:
Phone #:
Street Address:
State: Zip Code:
Provide a summary of the complaint, include names, dates, locations, etc.
Attach additional pages if necessary.
Provide a description of any attempts to resolve the issue.
I declare that the information on this form and all supporting documentation is true, correct and complete to the best
of my knowledge and belief.
Student Signature: Date:
For assistance: Counselor (Student Success Center, Suite 190) 763-576-7860 or Success Coach 763-576-7710
Submit this form to: Office of the Dean of Student Affairs