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Student ID

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Name

 

Email

 

Date

 

Home Phone

 

Cell Phone

 

Street Address

 

City

 

State

 

Zipcode

 

Academic Complaint

 

Student Life Complaint

 

Institution Complaint

 

Code of Conduct Complaint

 

Title IX Complaint

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Date Grievance Occurred 

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Describe the complaint in one sentence.

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Describe the complaint fully. Give as many details as possible.

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I attempted to resolve this issue informally with the appropriate person.


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I brought this matter to the attention of a college representative.


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I gave BCF ample time to reach a resolution


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Date of First Attempted Resolution

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Date brought to Representative

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Name of Representative