Student Formal Complaint Form
Anoka Technical College is an affirmative action, equal opportunity employer and educator, and a member of the Minnesota State Colleges and Universities system.
This document is available in alternative formats to individuals with disabilities by calling 763-433-1100, TTY: 7-1-1 or 800-627-3529.
1355 West Highway 10
Anoka, MN 55303
AnokaTech.edu
The Student Complaint Process can be found at:
http://www.anokatech.edu/en/AboutATC/PoliciesProcedures.aspx
This form is used when a student believes s/he has a valid complaint regarding an employee of the college.
The student is afforded due process and must follow the established procedure.
Name: Student ID:
Email Address:
Phone #:
Street Address:
City:
State: Zip Code:
Provide a summary of the complaint, include names, dates, locations, etc.
Attach additional pages if necessary.
A student must first attempt to discuss the complaint with the employee(s) and/or administrator(s) before submitting
this form. Provide a description of attempts to resolve the issue.
Identify the resolution or actions requested.
I declare that the information on this form and all supporting documentation is true, correct and complete to the best
of my knowledge and belief.
Student Signature: Date:
For assistance: Counselor (Student Success Center, Suite 190) 763-576-7860
Submit this form to: Office of Student Affairs
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