Student Complaint Form

**For an Academic Grievance, please read the “Addressing Academic Concerns and Appeals” section of the Student Handbook for additional details on how to address your concern.

Name*
First Last
Student ID*
Phone
Email*
Complaint Type*
Incident Date*
MM slash DD slash YYYY
Incident Time*
Campus Location*
Specific Location
Involved Parties
Number of people involved with this complaint*
- 1
- 2
- 3
- 4
- 5
- More than 5
Select "alleged" for the individual you are reporting a complaint about. Select "witness" if the person was present and noticed this behavior. Select "victim" if someone else was a victim of this behavior. If more than 3 people are involved in this complaint, please submit a second form.
Full Legal Name
CCC Student ID Number
Select Role
Mailing Address
Email
Enter the information below for an additional person involved in this complaint
Full Legal Name
CCC Student ID Number
Select Role
Address
Email
Full Legal Name
CCC Student ID Number
Select Role
Address
Email
Additional Details
Please describe your complaint in detail. Include the names of persons, locations, and dates involved. Use additional sheets if you need more space. If this complaint is against specific person(s), please list their names and titles*
What attempts have you made to resolve this complaint up to now? Please state who you contacted and what transpired*
What resolution would you consider fair? What resolution do you seek?*
Please add any additional information you would like to provide*
Is there any person who you do NOT want to be told of your complaint? (Keep in mind that it may be difficult to resolve if those involved cannot be asked to explain or respond). NOTE: RETALIATION AGAINST A STUDENT FOR MAKING A COMPLAINT IS ABSOLUTELY PROHIBITED, AND WILL BE CONSIDERED A SERIOUS VIOLATION OR PROFESSIONAL RESPONSIBILITY
Please attached supporting documentation that you would like to include with your report. 5GB maximum total size per file. Attachments require time to upload, so please be patient after submitting this form.
File
Max. file size: 64 MB.

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Additional Details