Student Complaint/Grievance Form

This form is to be used for general complaints or grievances. It is not to be used for general harassment, unlawful discrimination, sexual harassment or grade appeals.

Student Name: Student Name: First Last
Student ID Number:
Mailing Address: Mailing Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number: Phone Number: - ### - ### ####
Email Address:
Date of event that is subject of the Complaint/Grievance: Date of event that is subject of the Complaint/Grievance: / MM / DD YYYY
Description of Complaint/Grievance:
(include detail, names, dates, and events)
Explain how you believe College Policy was violated:
(College policies can be found on our website at frc.edu under the Administration/Board of Trustees tab)
Requested Remedy:
(describe what you would like to see done to resolve the situation)
I certify that the information provided on this form is true and complete to the best of my knowledge.

I certify that the information provided on this form is true and complete to the best of my knowledge. I agree I disagree