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PJC Student Appeal Form
PJC Complaint Appeal Process - If the student is dissatisfied with any Level of the Complaint process outcome (or if no response was received by the 10-day deadline), the student may appeal to the next Level by filing out this form. Appeals are typically reviewed within 15 business days.
Have you completed a complaint form already?
Please ensure you have submitted a complaint form and either received a response or allowed 10 days to pass since submission before completing the appeal form.
Student Information
Full Name:
Student ID Number:
0
Phone Number:
PJC Email Address:
Would you like to include your mailing address?
Mailing Address:
Apt or Suite Number:
City:
State:
Zip Code:
Incident Details
Date of Incident:
Date of Complaint Filed:
More Dates to Report?
Location(s):
Name(s) of Individual(s) Involved (if known):
Description of the Incident or Concern:
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
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: