Grievance Appeal form

The grievance flowchart can be found in the Student Handbook.

This form must be completed and submitted within seven (7) calendar days of the receipt of the decision.

Name of grievant

E-mail address

Phone number

Mailing address

Date of grievance decision

Grievance decision
Explain in detail the grievance decision you are appealing.

Statement of appeal
Explain new information that came forward after the grievance decision and/or describe why the grievance decision was arbitrary and/or capricious.

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