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General Grievance Form
For students to voice dissatisfaction with RPCC faculty and/or staff.
Student Information
Name of Student:
Lola Number:
Email address:
Student wishes to remain anonymous (check one): yes or no
Phone number:
In the space below, please describe with whom you are dissatisfied, and why. Please be as detailed as possible.
Also, attach any documentation relevant to your grievance.
Routing Instructions
Completed forms can be either:
1. Printed and delivered to the Student Services Office at the Gonzales, Reserve, or Westside Campus; or
2. Emailed to CSAO@rpcc.edu
For Office Use Only (if report is hand delivered):
Date Received:
This form must be given to the Chief Student Affairs Officer.
UPDATED: November 6, 2019