Student Grievance Form

Background Information

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your T# (Include the:

Nature of this report(Required):

This field is required.

Date of incident(Required):

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Which college employee or employees do you wish to make this grievance against?

Name

Role

Please address these prompts so that the professional staff members who respond will have a complete picture of the situation.

What policy, procedure, regulation, or law do you believe has been misapplied?(Required) This field is required.

Please describe what happened.(Required) This field is required.

What is your desired outcome?(Required) This field is required.

Have you already attempted to resolve this matter with the employee(s) who caused offense?(Required) This field is required.

Have you already attempted to resolve this matter with other college employees?(Required) This field is required.

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