Student Grievance/Complaint Resolution Form
Students have the right to file grievances concerning academic or non-academic matters. Grievances may be submitted openly, or anonymously. 

Students may submit grievances anonymously through the Grievance Resolution Form. While all anonymous complaints will be reviewed, the institution’s ability to fully investigate and resolve such complaints may be limited, as due process requires sufficient information and the opportunity for all parties to respond. 

If you wish to remain anonymous please input NA where Identifying information is requested. 
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Full Name *
Student ID *
Program of Study *
Contact Information *
Nature of Grievance *
Date of Incident  *
MM
/
DD
/
YYYY
Parties Involved (Instructor/Staff/Other Students) *
Describe the incident/concern in detail (If you wish to attach documentation please send files/documentation to StudentServices@TheoriaTechnical.com and address Director: Jenesis Hill)  *
Have you attempted to resolve this directly with the instructor/staff? *
If yes, describe the outcome. If not, please put No.  *
What outcome do you seek?  *
Student E- Signature & Date  *
Submit
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