SBVC - Student Complaint Reporting Form

Your information (Please include your Name and Student ID in the next section)

For us to address your complaint, it is important for you to complete the form with as much detail as possible. The more information you provide, the better it will assist us in having a complete picture of the situation. Please include the date of the incident, time, location, parties involved, witnesses, exact nature of the complaint, any attempts to resolve the complaint, copies of any written documentation and desired resolution.

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Your phone number:

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This will help us follow up if needed

Your SBVC email address:

Email address must be of a valid format.

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Your SBVC email is required; however, you may also add a personal email address

Nature of this report(Required):

This field is required.

Was an Employee Involved?(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

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For Example; In front of counter, hallway, reception desk, lobby etc

Involved Parties (may include person, place or process; e.g., library, courtyard, webadvisor)

1. Please type your name, select "reporter," and include your Student ID. 2. Click on "Add another party." 3. Add the name/location/process you are making a complaint about. 4. Select what describes the complaint the best.

Name/Location/Process

Label

Student ID Number (if student)

Questions

State nature of complaint: Please provide a detailed description of the incident using specific, concise, objective language (who, what, where, when, why and how.)(Required) This field is required.

Have you contacted someone else regarding the incident?(Required)

Yes No

This field is required.

If "Yes", please provide details such as who, what, where, when, why and how. This field is required.

If there are witnesses, please list below. This field is required.

Has the incident occurred before?(Required)

Yes No

This field is required.

If stated, "Yes" explain below. Please provide a detailed description of previous occurrences using specific, concise, objective language (who, what, where, when, why and how.) This field is required.

Have you attempted to resolve this incident?(Required)

Yes No

This field is required.

If "Yes", please provide details. The more information you provide, the better understanding we will have of your attempt to resolve this incident. This field is required.

How has or is this incident impacting you?(Required) This field is required.

What is the desired resolution you are seeking for this incident?(Required) This field is required.

May we follow-up with you if we have questions or need additional information? If so, please select your preferred method of contact and be sure to fill in that information above.(Required)

No follow-up Email Phone

This field is required.

Please add any additional information relevant to your complaint you feel is valuable. 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

Your information (Please include your Name and Student ID in the next section)

Involved Parties (may include person, place or process; e.g., library, courtyard, webadvisor)

Questions

Supporting Documentation

Submission