Grievance Form

Grievance Form
Name*

First NameLast Name
Student ID# (if applicable)
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Personal Details:*

StudentEmployeePublic or Other
Type of Grievance:*

AcademicSexual MisconductFacilities/SafetyHarassment/BullyingTheftWeaponsDiscriminationRudeness/ProfanityDrug/Alcohol/Tobacco/ParapheneliaOther
Describe your grievance, including specific details, locations, names, witnesses, dates, times, etc. *
Have you attempted to resolve your grievance informally?*

YesNo
If yes, please provide a brief summary:
What is your proposed resolution to settle the grievance?*
I declare that the information provided by me is true and correct I have read and understood the information contained on this form and the Grievance Policy as published on the Southwest Technical

College website (https://stech.edu/students/policies/)
Signature*

Clear
Should be Empty: