Student Grievance Report Form

Student Grievance Report Form
Vance Granville Community College (VGCC) is committed to providing a learning and working environment that promotes respect, responsibility, communication, collaboration, critical thinking and accountability. Students who experience a problem at VGCC and wish to report it as a grievance may do so using this form. Information shared on the form will be delivered confidentially to the VGCC Dean of Students.
Background Information
Date of Incident*

MonthDayYear
Date
Time of Incident*

Hour Minutes

AM/PM Option
Location of Incident*
Name*

First NameLast Name
Phone Number*
Please enter a phone number at which you can be reached.
Email*
example@example.com
Please describe the nature of your grievance in detail
Nature of Grievance:
I understand that this information will be used to resolve my grievance, which may involve an investigation. I understand that the College will make every effort to protect the privacy of all involved.
Consent*

I give my consent to reveal my identity to others to further the College's investigation and enforcement activities.I do not give my consent to reveal my identity to others to further the College's investigation and enforcement activities.
Should be Empty:

Background Information