Student Complaint Form

Register A Complaint

Please correct the following errors:

Step 1

Student Information

Name:

First Name

Last Name

Middle Initial

Email:

Phone:

Address:

Street/Mailing Address

City

State

Zip/Postal Code

Student ID:

Student Type:

Current Student Former Student

Step 2

Complaint Information

Complaint Category:

Service Building Individual Coursework Other

With Whom?

Department, office, or individual with whom you have a complaint:

Description:

Please describe your complaint:

Date(s) and Time(s):

Please list the date(s) and time(s) the event(s) occurred:

Location(s):

Please list the location(s) or place(s) the event(s) occurred:

Step 3

Additional Information

Communication:

Have you communicated with staff regarding your complaint?

Resolution:

Please describe your requested resolution for this complaint:

Process:

How did you find out about the Student Complaint process?

Northeast Community College will not allow any form of retaliation against individuals who file a complaint, or who cooperate in the investigation of the report. To the extent possible, the confidentiality of the report will be maintained.