Student Complaint - Lighthouse Christian College

Personal Information

Please refer to the Student Complaint Reporting Policy before submitting this form. This form is to be used to submit a formal complaint students have been unable to satisfactorily resolve with the faculty, staff, students or others involved.

This form is only to be submitted by students of Lighthouse Christian College. Please complete all fields so your complaint may be directed to the proper officials. Complaints may be submitted anonymously; however, unless you include your contact information, the college will be unable to investigate your complaint or respond back to you regarding the matter.

Today's Date *

Full Legal Name (as enrolled)

Student Number

Major

Phone Number

Email

Email Address

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Method of Contact

Email
Phone
U.S. Mail

Grievance Details

Please provide information about the event leading to the grievance.

Date of Incident *

Location of Incident *

Time of Incident *

What Was Your Involvement? *

Who was directly involved? *

Please list names and titles of those who were directly involved in the incident. Please exclude witnesses from this list.

Who witnessed the incident? *

Please list the names and titles of those who witnessed the incident.

Describe the incident. *

Please provide as much detail as possible, including relevant events that led up to the incident. What attempts have you made to resolve this complaint up to now? Please state who you have contacted and what transpired.

If any policies, procedures, or other guidelines were violated during the incident, please list them below.

Cite specific information from the student handbook when possible.

Desired Outcome

What resolution would you consider fair? What resolution do you seek?

Please list any additional comments or information.

ie. If you have made prior attempts to report, why do you think the complaint was not able to be resolved?
**If There is any person who you DO NOT want to be told of your complaint?
(Keep in mind that it may be difficult to resolve if those involved cannot be asked to explain or respond).

Certification *

I understand and agree to the terms listed here.

I submit this form and confirm that everything on it is true and complete to the best of my knowledge.
I grant permission for this complaint to be forwarded to Lighthouse Christian College officials for purposes of investigation and response. I understand that providing false information can lead to disciplinary action.

Signature

Clear Signature