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Student Grievance Policy
(ARC-PA 5th Edition Standards A3.15g)
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Fields
Student Name
*
First Name
*
Last Name
*
Your Email
*
Instructor/Faculty/Staff Name
*
First Name
*
Last Name
*
Please describe the issue in detail:
*
Witnesses or Supporting Person
Are there witnesses or supporting parties involved?
*
Yes
No
Witness or Supporting Party's Name
*
First Name
*
Last Name
*
Witness or Supporting Party's Name Phone Nuber
If unknown, please leave blank.
Description of Actions Taken
Describe any actions taken at this time to address this issue or situation (include dates, actions, and participants):
*
Official Use Only
Received by:
Date received:
Date SPC Chair received:
SPC review date (five days):
Date faculty/instructor response was sent to student and SPC members (five days):
Student request appeal to the Program Director:
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