SOUTHERN CRESCENT TECHNICAL COLLEGE
INFORMAL GRIEVANCE/COMPLAINT FORM
A student should use this form to file a grievance/complaint. Grievable issues relate to student advisement, improper disclosure of
grades, unfair testing procedures, and poor treatment of students.
[This procedure does not address complaints related to the unlawful harassment (including sexual harassment), discrimination
and/or retaliation for reporting harassment/discrimination against students. Those complaints are handled by the Unlawful
Harassment and Discrimination of Students Procedure. Non-grievable Issues are issues that have a separate process for
resolution (i.e. disciplinary sanctions, FERPA, financial aid, academic grades, etc.) and student must take advantage of the process
in place.]
Please ensure all necessary information/relevant information is included. All correspondence concerning this matter will be sent to
the address or e-mail provided below.
Name of Student: ______________________________________ Student I.D. #: ______________________________
Home Address: ____________________________________________________________________________________
Phone: ____________________________________ Email: ________________________________________________
Program of Study: ______________________________________ Campus: ___________________________________
Statement of Grievance/Complaint (Use additional sheets if needed.):
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Remedy Requested:
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Student Signature: ___________________________________________________ Date: ________________________
College Representative Signature: ______________________________________ Date: ________________________
As set forth in full in the Student Handbook/Course Catalog, Southern Crescent Technical College is an Equal Opportunity
Institution and does not discriminate on the basis of race, color, national origin, sex, age or disability.
Revised: 10/23/2018
Received by: _____________
Date: ___________________
Referred to: _____________
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Move to Formal Grievance Process:
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Within 15 business days, of the incident being grieved, student must
file a formal grievance in the Office of Vice President for Student
Affairs or the tech college president’s designee.
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