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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
Date Grievance Occurred
Describe the complaint in one sentence.
Describe the complaint fully. Give as many details as possible.
I attempted to resolve this issue informally with the appropriate person.
I brought this matter to the attention of a college representative.
I gave BCF ample time to reach a resolution
Date of First Attempted Resolution
Date brought to Representative
Name of Representative
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