| RESPONSE TO STUDENT GRIEVANCE | ||||||||||||||
| Use this form to reply to the Student Complaint Form on which you have been named as the respondent. Please take the time to print or write clearly. | ||||||||||||||
| Your Name: | ||||||||||||||
| Your I.D. Number: | ||||||||||||||
| Today's Date: | ||||||||||||||
Your Response to the Alleged Grievance
| Instructions: | Be specific. Describe clearly the alleged grievance. (If necessary, seek assistance from a person of your choice in preparing this form.) | |||||||||||||
| Please attach to this form any written and signed statements or other evidence which support your description of the alleged grievance. | ||||||||||||||
| Note: If you have already completed and turned in a Response to Student Complaint Form (Form 2530/002) and have no additional information to provide you may check here: ________ and just sign and date the form on the second page. | ||||||||||||||
| Form 2530/004 (page 1 of 2) (12/12) | ||||||||||||||
| Response to Alleged Grievance (Continued): | ||||||||||||||
| Signature: _______________________________________ Date: _______________________________ | ||||||||||||||
| Form 2530/004 (page 2 of 2) (12/12) | ||||||||||||||
