PJC Student Complaint Form

PJC Formal Student Complaint Process- Students are encouraged to first seek informal resolution by discussing concerns (via email, phone call, or in-person) directly with the individual or department involved (e.g. course instructor, Program Coordinator, Dean, staff member, Department Director, etc.). If the issue is not resolved, the student may file a formal written complaint. 

Have you sought an informal resolution already? 

In order to continue through the formal complaint process, you should first seek an informal resolution with the individual(s) involved.

Student Information

Full Name:

Student ID Number:

Phone Number:

PJC Email Address:

Would you like to include your mailing address?

Mailing Address:

Apt or Suite Number:

City:

State:

Zip Code:

Type of Complaint

Please select one:

Please specify the type of complaint:

Incident Details

Date of Incident:

More Dates to Report?

Date of Incident:

Date of Incident:

Location(s):

Name(s) of Individual(s) Involved (if known):

Description of the Incident or Concern:

Steps Taken So Far

Have you spoken with the person involved?

What was the result?

Have you reported this concern to anyone else at the college?

Who did you report the incident to, when did you report it, and what was the outcome?

Desired Resolution

What outcome are you seeking or what would you consider a fair resolution to this issue?

Supporting Documentation

Attach any relevant documents to the complaint (emails, screenshots, assignments, medical documentation, etc.)

Supporting Documents

Supporting Documents

Supporting Documents

Student Certificate

By checking below, I affirm that the information provided is true and complete to the best of my knowledge. I understand that this complaint may be shared with appropriate college personnel for the purpose of resolving the issue.

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Date: