Student Academic Grievance Petition

Student Academic Grievance Petition
A student with an academic complaint shall follow the proper steps:
1. Student shall initiate the informal academic resolution procedure by meeting with the instructor of the course.
2. If there is no resolution, the student meets with the appropriate Dean.
3. If there is no resolution, the Vice President of Student Services is notified by the Dean of a pending student academic grievance and a Facilitator is assigned to assist the student through the formal student academic grievance process.
A full outline of the Academic Grievance procedure can be found in the Student Handbook.
I affirm I have followed the steps of first meeting with the instructor of the course, followed by the appropriate division Dean, and no resolution was reached.*

Student Information
Name*

First NameLast Name
ctcLink Student ID*
Email Address*
example@example.com
Phone Number*
Phone number with area code

Course Information
Quarter Course was Taken*
Course Department*
e.g., Math
Course Number*
e.g. 146
Instructor's Name*
Grade Received:*

Reason for Academic Grievance:
Include the nature of your academic grievance, a summary of actions taken by you to resolve the grievance up to this point, and your proposed solutions.*
You may attach additional pages below, as necessary.

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Lower Columbia College does not discriminate on the basis of sex and prohibits sex discrimination in any education program or activity that it operates, as required by Title IX, including in admission and employment. Lower Columbia College provides equal opportunity in education and employment and does not discriminate on the basis of race, color, national origin, citizenship or immigration status, age, perceived or actual physical or mental disability, pregnancy, genetic information, sex, sexual orientation, gender identity, marital status, creed, religion, veteran or military status, or use of a trained guide dog or service animal as required by Title VI of the Civil Rights Act of 1964, Title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Sections 504 and 508 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and ADA Amendment Act, the Age Discrimination Act of 1975, the Violence Against Women Reauthorization Act and Washington State's Law Against Discrimination, Chapter 49.60 RCW and their implementing regulations. All inquiries regarding compliance with Title IX, access, equal opportunity and/or grievance procedures should be directed to Vice President of Foundation, HR & Legal Affairs, 1600 Maple Street, PO Box 3010, Longview, WA 98632, title9@lowercolumbia.edu, Phone number, (360) 442-2120, Phone number/TTY (800) 833-6388. The notice of nondiscrimination is located at https://lowercolumbia.edu/disclosure/non-discrimination/.
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Student Academic Grievance Petition

Student Information

Course Information

Reason for Academic Grievance: