Clark College Student Formal Complaint Form

For information on the Student Complaint Policy see 735.000 in the Administrative Procedures Manual.

For assistance with questions or in completing this form you may contact studentcomplaints@clark.edu.


Name:

Last

First

M.I.


Street Address:

City

State

Zip


Telephone Number:

Clark Student Email Address:   

Term and Year Last Attended   

Area of the College the complaint is about:
Academic policy/procedure
Instructor
Services
Administration
Staff
Facilities


Location where the incident occurred:
Columbia Technical Center (CTC)
Main Campus
Clark at WSU-Vancouver
Other    

If this complaint concerns an instructor or class, please fill out the class information:

Instructor Name

Quarter

Class Course & ID



Please describe how you have first attempted to resolve this issue through the Clark College informal complaint process?

Who did you talk with and when?



What was the outcome and why are you pursuing the formal complaint process?

Please note that Clark College will only investigate formal complaints after the student has first attempted to resolve the issues informally.

Explain the circumstances of this formal complaint. Be specific in explaining your concerns; include dates and the names of individuals who may be involved. Please attach any supporting documentation or additional information you think is relevant to this form.



Describe your attempts to resolve the issues leading to your formal complaint. Be specific in explaining your efforts; include dates, campus location, names of college staff, and names of college department and include information about the college's response. Please attach any supporting documentation or additional information you think is relevant to this form.




What would you consider to be an acceptable resolution to your complaint?



Have you filed a complaint with any other organization or entity related to this formal complaint?
Yes
No


If yes, please provide us with the name of the organization(s) and the outcome.




Clark College will use the information you provide to assist with resolving your formal complaint. By signing this document and submitting a formal complaint, you consent to Clark College's disclosure of any protected or confidential information that may be needed to review your complaint, including referring complaints to another organization with jurisdiction and authority over the issue.

The information given in this complaint is true and accurate to the best of my knowledge and I understand that if I fail to respond to requests for additional information or to questions about this complaint, the college may dismiss my complaint.
Please note: Your submission of this document serves as an electronic signature and indication that the information you have submitted is true and accurate to the best of your knowledge.

Do not send confidential information via email.
If you have supporting documentation that is confidential, please mail this to:
Student Complaints
1933 Fort Vancouver Way
Gaiser Hall Rm 215
Vancouver, WA 98661

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