General Grievance Form
For students to voice concerns/dissatisfaction with RPCC faculty, staff, or facilities.
Student Name
*
First Name
Last Name
Student LoLA Number
Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Do you wish to remain anonymous?
*
Please Select
YES
NO
Grievance Summary
Grievance Type
*
Please Select
Facilities
Staff (Non-Faculty)
Technical Faculty
Energy Sciences Faculty (PTech, I&E)
Health Sciences Faculty
General Education Faculty
Does this grievance include claims against a Dean or Department Head? (Routed to AVC Academic Affairs)
*
Yes
No
+
-
Month
-
Day
Year
Please share details regarding your concern or dissatisfaction and why, in the space below. Also share any documentation relevant to your grievance through the upload link.
*
Please upload relevant documents here.
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Desired Outcome
I am aware that this document may be reviewed by relevant Deans, the Associate Vice Chancellor of Student Services, or routed to other relevant parties for thorough investigation within 3-5 days. I will receive follow-up communication by the email on file.
*
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