Complaint Resolution Form - North Orange Country Community College District

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C
R
F
OMPLAINT
ESOLUTION
ORM
Name: _______________________________________Student ID#: ____________________________
Address: ____________________________________________________________________________
Phone Number: ________________________________Email: _________________________________
What is the nature of your complaint? (include important details) _______________________________
____________________________________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
When did this happen? _________________________________________________________________
____________________________________________________________________________________
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What have you done to try to resolve this issue? _____________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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How do you envision this issue being resolved? _____________________________________________
____________________________________________________________________________________
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Student Signature:__________________________________Date: ______________________
Please submit this form to the DSS front-office staff.
Revised 10/28/2008

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