IE_Student Grievance Form

Elim Bible Institute and College

Student Grievance Form

Please fill out the following information if you would like to issue a formal complaint to EBIC. All complaints will be reviewed by the President and the Executive Vice President and Provost and addressed in a timely manner.

Date of Complaint*

MonthDayYear

Is this Complaint yours?*

First formal written notification (first-time filling out this form)Appeal of Resolution from the first written notification

Briefly explain your complaint (Please include any dates, times, specific individuals and details of the complaint).*

Relate any actions you have already taken to address this complaint.*

What is the desired resolution you are seeking for this complaint.*

Contact information for follow-up purposes:

Student Name:*

First NameLast Name

Student Email:*

Student Phone Number: (optional)

Area CodePhone Number