Sandhills Community College
Student Grievance Form
__________________________
Date received by Student Grievance
Committee or Senior Vice President
Grievance is defined as any matter of student concern or dissatisfaction within the control of the
college, except for the following: grades, attendance policies and matters of a purely academic
nature, matters involving allegations of sexual harassment, residency classification, and financial aid.
It is assumed that students will make every effort to resolve a presumed grievance via conversation
with the person or persons involved prior to setting in motion the grievance procedures. The college
encourages students who have problems to talk out these differences and make every effort to come
to a mutually satisfactory understanding before involving the wider college community in the
grievance process. Counselors will make every effort to assist with such attempts.
PART I: Student Information
[This form must be drafted and completed by the student, and information must be either typed or printed.]
Name: __________________________________________ Phone Number: ______________________
(
number where you may be reached)
E-mail address: ___________________________________ Major: ____________________________
Mailing Address: ___________________________ City: ____________________ Zip: ____________
Date of event or condition: _______________ Date discussed with Counselor: ___________________
(if applicable)
PART II: Formal Grievance to Student Grievance Committee (or senior vice
president if continuing education student).
[This form must be drafted and completed by the student, and information must be either typed or printed.
Student should keep one copy and give one to the chair of the Student Grievance Committee, or in the case
of continuing education issues, the senior vice president, within three (3) business days of the student’s
receipt of notice of the decision by the vice president of student services and academic support, dean of
instruction, dean of continuing education, or SCC Hoke Center Director.]
Specific statement of grievance.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Incidents and/or facts supporting claim of grievance. (Attach additional sheets if necessary.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Requested solution or remedy.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Particular area of disagreement with decision of the vice president of student services and academic
support, dean of instruction, dean of continuing education, or SCC Hoke Center Director.
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________________________
Student’s signature _____________________________________ Date ________________________
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