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Formal Student Grievance Form

The primary objective of a student grievance procedure is to ensure concerns are promptly dealt
with and resolutions reached in a fair and just manner. It is essential each student be given
adequate opportunity to bring complaints and problems to the attention of the College with the
assurance each will be heard and due process afforded the student. For more information, please
refer to Procedure 551.1 in the Procedure Manual at
http://www.azwestern.edu/hr/procedures.html

Definitions:
Grievance is a complaint by an AWC student involving an alleged misapplication or violation of
any College policy or procedure that adversely impacts the student, or any other dispute within
the College that directly impacts the student in adverse manners. A Grievance may include, but is
not limited to, complaints alleging (a) mistreatment by a College employee, (b) errors in the
assessment of fees or other financial obligations, (c) registration errors, (d) loss of financial aid
eligibility, and/or (e) student housing issues. Student is an individual who is matriculated or
otherwise enrolled to attend class full or part-time at AWC.
Issues and Disputes Not Covered on This Formal Student Grievance Form:
1. Requests to review and challenge contents of student records will be processed according
to the College procedure #545.1 Student Record Confidentiality.
2. Grievances or concerns involving harassment or discrimination on the basis of race,
color, religion, sex, age, national origin, disability, or Vietnam-era veteran status will be
processed according to College procedure #455.2 Grievance for Specified Civil Rights
Grievances.
3. Grievances relating to sexual harassment will be processed according to College
procedure #460.1 Prohibition Against Sexual Harassment.
4. Appeals of disciplinary actions will be handled as provided in College procedure #550.1
Student Code of Conduct.
5. Appeals or petition regarding instructional or academic issues will be processed
according to College procedure #551.2 Instructional Grievance Petition.
6. Complaints that, on their face, are not subject to possible resolution in a student grievance
context. (An example would be a student complaint where the student's requested relief is
prohibited by state or federal law.)

STUDENT INFORMATION:
Please Print
Submission Date: 03/30/2016
Name:

AWC Student ID #:

Home Phone:

Address:

Work Phone:

City:

State:
Email:

Zipcode:

Confirm Email:
If student is a minor they must have the signature of parent or legal guardian to proceed.

Informal Resolution:
Have you tried to resolve the problem informally with the person(s) alleged to have caused the
grievance or with the direct supervisor?
Yes

No

Detail description of incident: Please include names of other persons involved, departments, any
witnesses and support documentation. If additional space is needed please use another sheet of
paper and attach to this form.

What Are You Requesting as a Proposed Solution?

Arizona Western College does not discriminate in admission or access to, or treatment in
employment in, its services , programs, or activities on the basis of race, color, national origin,
sex, religion, age, or disability.