Date
STUDENT CODE OF CONDUCT COMPLAINT FORM
Any administrative official, faculty member, student, security officer or staff member may file a complaint with the Vice
President for Student Affairs against any student for a violation of the Student Code of Conduct. The individual(s)
initiating the action must complete a Student Code of Conduct Complaint Form and forward it directly to the Vice
President for Student Affairs.
(Reference: SCTC Student Handbook under the "Disciplinary Procedure and Student Conduct")
Student Name:
Student ID#
Telephone: Em
ail:
Program:
:
Department:
S
ite Code Violation(s)
E
xplanation of Complaint:
Witne
ss(es):
:
:
Have you in good faith attempted to resolve the issue? Yes No If yes, please describe the resolution:
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: 10.24.2018
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