Student Grievance

Background Information

This section is for background information about you, the complainant. Please provide the information listed below.

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Your full name:

Your Durham Tech Student ID #:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

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You must choose from this list; these are the only official reasons for a grievance

Urgency of this report(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location or course:

Involved Parties

Include as much information as you know about each involved party, including you (the complainant), the person against whom you have the concern (the respondent), and anyone else involved with the issue (witness).
NOTE: Be sure to add your information in this section, too.

Enter full name here

Choose the appropriate role for each person involved

Durham Tech ID #, if known

Phone number

Email address

Address or office location

Questions

Complete the following questions IF you have reviewed the official college Student Grievance Procedures and have followed the steps outlined in those procedures. If you need assistance, contact Ms. Karen Mosley at mosleylk@durhamtech.edu.

STEP 1: Please indicate the date when you met with the individual(s) against whom you have the concern, along with their name(s). This date MUST be within 6 working days of the incident.(Required) This field is required.

STEP 2: Please indicate the date when you met with the supervisor of the individual(s) against whom you have the concern, along with his/her name. This date MUST be within 10 working days of the meeting with the individual(s) against who you have the concern. NOTE: Your grievance will be denied if you have not met with the supervisor prior to submitting the form. IMPORTANT NOTE: Your grievance is likely to be denied if you have not completed Step 1 and Step 2 in the process. Please be sure to discuss your concerns with your faculty or staff member and his/her supervisor prior to submitting an official grievance.(Required) This field is required.

STEP 3: Please indicate today's date here. This date of submission must be within 10 working days of the meeting with the supervisor in Step 2.(Required) This field is required.

Please explain the nature of your grievance here. If the grievance is related to the final grade in a course, be sure to give the course and section numbers along with the name of the faculty member(s) teaching the course. As a reminder, you may not file an official grade grievance unless you are grieving the final course grade. NOTE: You may request assistance from a counselor in completing this process and this form. If you need help, contact Counseling Services at counseling@durhamtech.edu.(Required) This field is required.

Please explain the resolution you are asking for here.(Required) This field is required.

If this grievance is related to a course, please restate the course and section numbers here. This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission