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Hazard Community and Technical College
STUDENT COMPLAINTS PROCEDURE
FORMAL COMPLAINTS FORM
This form is designed for use with the Formal Stage of the HCTC’s Student Complaints Procedure. Please ensure that you have read and understood the Procedure before completing this form. The completed form should be returned to the President’s Office, Jolly Classroom Building on the Hazard Campus.
Part I - Student Information
Name
Address (for response)
Student ID No.
Telephone No
Email:
Part II – Details of Complaint (Please explain what you are complaining about and why. Please feel free to attach additional sheets if necessary)
………………………………………………………………………………………………………… Section III – Redress (Please state clearly what redress you are seeking)
Section IV Before a complaint can be raised formally, it must have been raised informally with one or more of the following:
Please indicate below where the complaint has been raised
(1) Name:
Title:
Date Raised:
(2) Name:
What was the outcome: (please include why you are still dissatisfied)
……………………………………………………………………………………………………...
Signature of complainant: _____________________________________________
Date:
For office use only
Date received: ____________________________________________________________
Acknowledgement date sent: ________________________________________________
Referral Made for Follow-up Employee Name: __________________________________________________________
Date: __________________________________________________________________