STUDENT ACADEMIC COMPLAINT FORM
Student Name: ID#:
Student Signature:
Complaint Regards Course and Section: Term:
Instructor’s Name:
The student Academic Complaint Procedure is available to students who have concerns about academic
matters such as grades and course requirements. The procedure consists of 2 stages, an informal stage and a
formal stage. The informal stage must be completed before the complaint procedure can move into the formal
stage. Please refer to CCAC Student Handbook, on the CCAC website.
Use the following checklist in order to move through the complaint procedure. When you have completed a step,
place a check () on the line indicating that you have completed that step.
TIMELINE: As a general rule, complaints must be initiated within 2 weeks after discovering your concern.
What was the date the complaint? What is today’s date?
INFORMAL STAGE: Most complaints are resolved at the informal stage. In this stage, you must make every
effort to resolve the complaint by discussing it with the faculty member involved.
1. Did you discuss the complaint with the appropriate faculty member?
Yes
On what date and where?
No
2. Describe the outcome:
Yes No
3. Is your complaint resolved?
If no, describe why.
If the complaint is not resolved by meeting with the faculty member, either the student or the faculty member can
request a meeting with the appropriate department head. Keep in mind that in order for unresolved complaints to
move to the formal stage, it is a good idea to meet with the department head.
A meeting took place between you and
, the department head.
What was the date of the meeting?
Describe the outcome of the meeting:
FORMAL STAGE: Complaints not resolved in the Informal Stage must be submitted in writing by the student to
the Campus Associate Dean of Academic Affairs or Associate Dean of Nursing. Please note that you cannot move
to the formal stage unless you have completed all steps in the informal stage.
TIMELINE: The deadline for filing a FORMAL complaint is the middle of the following semester, coinciding with the
last date for students to complete “I” grade work.
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Student Name:
ID#:
STUDENT’S WRITTEN DESCRIPTION OF THE FORMAL COMPLAINT
Please carefully answer all of the following questions since your responses will determine the disposition of your
complaint. Attach additional written statements to this form.
What is the date on which you will submit your written complaint to the Campus Associate Dean of Academic
Affairs or Associate Dean of Nursing?
Clearly describe your concerns.
Clearly describe the events that led to your concerns.
Clearly state what you seek as a resolution to your concerns.
Clearly state why you feel you are justified to get the desired resolution.
Associate Dean’s Signature____________________________
Date Rec.: _______________
WHAT HAPPENS NEXT:
1) The faculty member against whom the complaint has been filed will be given an opportunity to respond in writing.
2) Based on your submitted complaint and other relevant material, the Associate Dean of Academic Affairs or Associate Dean of
Nursing may make a decision on the matter or refer the complaint to a campus Academic Complaint Appeal Committee for a
recommended resolution. If that is the case:
a. The campus Academic Complaint Appeal Committee will be convened within two weeks of the filed complaint.
b. The campus Academic Complaint Appeal Committee shall forward its written recommendation within 72 hours of the
close of
its deliberations to the campus Associate Dean of Academic
Affairs or Associate Dean of Nursing.
c. The campus Associate Dean of Academic Affairs or Associate Dean of Nursing may accept, reject, or modify the
recommendation of the campus Academic Complaint Appeal Committee.
3) The decision of the appropriate Associate Dean of Academic Affairs or Associate Dean of Nursing is forwarded to you by
certified mail.
4) You have the right to appeal the decision of the Associate Dean of Academic
Affairs or Associate
Dean of Nursing.
5) If you choose to appeal
the decision of the Associate Dean of Academic Affairs or Associate Dean of Nursing, you must do so
within 7 days of the receipt of the certified letter.
6) If you choose to appeal
the decision of the Associate Dean of Academic Affairs or Associate Dean of Nursing, you must do so
in written form to the campus
Dean of Academic Affairs.
7) The decision of the campus Dean of Academic Affairs is final.
AL:10.23.19
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