Student Grievance Form - Converse College
This form may only be reviewed and considered after the student has utilized all appropriate appeals at the department level.
Name of Student *
Your answer
Phone number *
Your answer
Email address *
Your answer
General Nature of Complaint (check one): *
Specifics regarding complain/concern: *
Your answer
Previous actions taken regarding complaint (person(s) with whom you have spoken, date of conversation(s), other): *
Your answer
Applicant's pledge *
All information provided is truthful and accurately reported.
Your answer
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