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Student Grievance Form

School
Campus

Next Page

Type of Grievance

Please describe the grievance in the space below using concise and objective language.

If the grievance you are describing is a specific incident or behavior, please include as many of the following details as possible/applicable: location, date, time, names of those involved, whether those involved were students, faculty or staff members.

By submitting this form, I am indicating that the information on this form is true, correct and complete to the best of my knowledge. I understand that any intentional misrepresentation of information may result in disciplinary actions.

Test/Sample Form

Step 1

*Age Requirement

Address

Step 2

Yes or No?
Date time range :
Multiple or single choice
*Rules, Terms, and Policy Acknowledgment