DCB Student Handbook 2023-2024

32 | P a g e D C B S t u d e n t H a n d b o o k Student Complaint Form Name: ____________________________________________________________________________ ID: __________________________ E-mail address: ___________________________________________________________ Phone: ________________________________ Name of faculty/staff member(s) against whom complaint is lodged:__________________________________________________________ Nature of the complaint: ____________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _____________________________________________________________________________________________ Facts (What evidence supports the complaint? How may this be verified?) ___________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _____________________________________________________________________________________________ History (What steps have been taken previously to remedy this situation? Who has been consulted and when?) _____________________________________________________________________________________________ _____________________________________________________________________________________________ Remedy (What solution, if any, do you seek?) __________________________________________________________________________ Witnesses (If Any) ________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Signed _______________________________________________________________________ Date _____________________________ Address_________________________________________________________________________________________________________ Return this form to: Associate Dean for Student Services Thatcher Hall, Room 118