STUDENT COMPLAINT
This form is to be used in accordance with Board Policy 07.29 Student Complaints and the related Procedures for
Resolving Student Complaints. Additional information is available in the online Student Handbook and Right to Know
or in printed copy at Counseling Services. Students are encouraged to meet with an academic counselor for additional
information regarding the complaint procedure.
Student Name: Student ID#:
Address: Phone Number:
Student Signature: Date:
DESCRIPTION OF COMPLAINT
The description must be completed by the student and should include the following:
1. A summary of the complaint.
2. The facts on which the complaint is based.
3. The resolution requested.
ATTACH ADDITIONAL INFORMATION AS NEEDED
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PLEASE FOLLOW THE REQUIRED DOCUMENTATION PROCESS.
STEP ONE: RECOMMENDATION FROM FACULTY OR STAFF MEMBER INVOLVED:
Date: Signature:
STEP TWO: RECOMMENDATION FROM IMMEDIATE SUPERVISOR/REVIEW BOARD:
Date: Signature:
STEP THREE: RECOMMENDATION FROM VICE PRESIDENT:
Date: Signature:
FINAL ACTION:
Date: Signature:
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