Student Complaint Form

^* Indicates required field

Student ID ^*

First Name ^*

Last Name ^*

Student Email

Student Phone

Complaint Subject ^*

College Employee involved

Course (if Applicable)

Date of Occurrence

If the issue is course related have you discussed it with your instructor?

Describe Complaint (provide detailed description of issue)

Expected Outcome

For Non-Academic Complaints against a College Employee (select all boxes that apply)

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