Formal Complaint Form Accs (Page 2 of 2) in pdf

ALABAMA COMMUNITY COLLEGE SYSTEM (ACCS)

FORMAL COMPLAINT FORM

Complainant’s Name___________________________________________________

Address _____________________________________________________________

City____________________ State_________________ Zip Code _______________

Home Phone _________________ Email Address ____________________________

College or Entity Name ________________________________________________

Are you currently employed by the college you complaining about? _____________

If so, what is your position? __________________________________________

If no, what is your relationship with the college? __________________________

Date of Complaint Occurrence ____________________

Provide the specific details of the complaint.

_____________________________________________________________________________________

Have you followed the local complaint process? Yes _____ No _______

If no, stop here. You must file your complaint through the local complaint process.

If yes, what was the result? ___________________________________

Please provide a written explanation as to what remedy you are seeking from this

office._______________________________________________________________________________

_____________________________________________________________________________________

I authorize the ACCS System Office to submit my complaint and/or any documents concerning the

complaint to the appropriate ACCS entity reported herein. I further hereby acknowledge that I have

submitted the information above based on credible and verifiable information supporting the allegations

contained in the complaint.

__________________________________

____________________

Signature

Date

Formal Complaint Form Accs Page 2