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Formal Student Grievance Form

The primary objective of a student grievance procedure is to ensure concerns are promptly dealt with and resolutions reached in a fair and just manner. It is essential each student be given adequate opportunity to bring complaints and problems to the attention of the College with the assurance each will be heard and due process afforded the student. For more information, please refer to Procedure 551.1 in the Procedure Manual at http://www.azwestern.edu/hr/procedures.html

Definitions:

Grievance is a complaint by an AWC student involving an alleged misapplication or violation of any College policy or procedure that adversely impacts the student, or any other dispute within the College that directly impacts the student in adverse manners. A Grievance may include, but is not limited to, complaints alleging (a) mistreatment by a College employee, (b) errors in the assessment of fees or other financial obligations, (c) registration errors, (d) loss of financial aid eligibility, and/or (e) student housing issues. Student is an individual who is matriculated or otherwise enrolled to attend class full or part-time at AWC.

Issues and Disputes Not Covered on This Formal Student Grievance Form:

  1. Requests to review and challenge contents of student records will be processed according to the College procedure #545.1 Student Record Confidentiality.

  2. Grievances or concerns involving harassment or discrimination on the basis of race, color, religion, sex, age, national origin, disability, or Vietnam-era veteran status will be processed according to College procedure #455.2 Grievance for Specified Civil Rights Grievances.

  3. Grievances relating to sexual harassment will be processed according to College procedure #460.1 Prohibition Against Sexual Harassment.

  4. Appeals of disciplinary actions will be handled as provided in College procedure #550.1 Student Code of Conduct.

  5. Appeals or petition regarding instructional or academic issues will be processed according to College procedure #551.2 Instructional Grievance Petition.

  6. Complaints that, on their face, are not subject to possible resolution in a student grievance context. (An example would be a student complaint where the student's requested relief is prohibited by state or federal law.)

STUDENT INFORMATION:

Please Print
Submission Date: 12/21/2014 AWC Student ID #:
Name: Home Phone:() -
Address: Work Phone:() -
City:
State:
Zipcode:
Email:
Confirm Email:

If student is a minor they must have the signature of parent or legal guardian to proceed.

Informal Resolution:

Have you tried to resolve the problem informally with the person(s) alleged to have caused the grievance or with the direct supervisor?

Yes No

Detail description of incident: Please include names of other persons involved, departments, any witnesses and support documentation. If additional space is needed please use another sheet of paper and attach to this form.


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What Are You Requesting as a Proposed Solution?


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Arizona Western College does not discriminate in admission or access to, or treatment in employment in, its services , programs, or activities on the basis of race, color, national origin, sex, religion, age, or disability.

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