Complaint/Grievance Form

BACKGROUND INFORMATION

The information requested below will help the College complete a full investigation. If a reporter fails to provide any identifying or contact information, it may limit our ability to look into or fully respond to the complaint.

Your full name:

Your position/title:

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Examples include student, community member, faculty, or staff.

Your phone number:

Your email address:

Email address must be of a valid format.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

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Please indicate if information will be helpful to investigation.

Location related to complaint(Required):

This field is required.

Specific location:

PEOPLE INVOLVED

Please provide information about the people involved and any witnesses that would be helpful to the investigation/complaint review. The College understands that the information reported is to the best of your knowledge.

Name of Person Involved

Select Gender

Select Role

ID Number

DESCRIPTION OF THE COMPLAINT/GRIEVANCE

Please respond to the questions below to help us expedite our investigation.

Please provide a detailed description of the complaint/grievance.(Required) This field is required.

Have you attempted to resolve this issue with an informal resolution process? If yes, please state with who and the outcome to date.(Required) This field is required.

Is there anything else you would like us to know about the situation? This field is required.

What is the outcome (resolution) you are requesting?(Required) This field is required.

What is the best way to contact you in regard to this complaint?(Required) This field is required.

SUPPORTING DOCUMENTATION

Please provide copies of any supporting documentation that may assist the us with our review process. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

SELECT DACC OFFICIALS TO COPY

Please select the DACC Officials you would like cc'd (copied) in regard to this report.

Provost and Vice President of Academic Affairs / Student Services - Dr. Carl Bridges

Assistant Vice President of Student Services - Brian Hensgen

Safety and Security Chief - n.howie@dacc.edu

Email me a copy of this report

BACKGROUND INFORMATION

PEOPLE INVOLVED

DESCRIPTION OF THE COMPLAINT/GRIEVANCE

SUPPORTING DOCUMENTATION

SELECT DACC OFFICIALS TO COPY

Submission