Grievance Form for Students

Grievance Form for Students
Student's Full Name*
Student A-Number
Cell Phone Number or Contact Number*
Email*
example@example.com
Address*

(Street Address or P.O. Box)

Street Address Line 2

(City)(State)

(Zip)
Summarize your complaint/grievance in less than 8 words (i.e. what is the topic or main category?).*
Describe your complaint/grievance in detail. Discuss the issue and specify any dates, staff you dealt with, what steps (if any) you have taken to resolve the issue, monies owed, balances due, or anything else pertinent to the grievance.*
What resolution/outcome are you seeking?*
Attach any documentation which will help describe the problem and substantiate your allegations.

Cancelof
I certify that the information listed on this form and any supporting documentation is true and correct to the best of my knowledge.
(Student's Signature)*

Clear
(Date)*

MonthDayYear
Date
This form and attachments will be electronically submitted to the Office of the Vice President for Student Services.

It is the policy of the Alabama Community College System and Snead State Community College, a postsecondary institution under its control, that no person shall, on the grounds of race, color, disability, sex, religion, creed, national origin, or age, be excluded from participation in, be denied benefit of, or be subjected to discrimination under any program, activity, or employment.
Should be Empty: