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All fields are required; enter NA if not applicable.

YES, I have attempted to resolve this complaint informally with the party/parties involved as outlined in the CTC Student Handbook.

I AM:

Current Student
Prospective Student
Former Student
Other 

LOCATION:

Central-Killeen
Europe
Fort Hood
Pacific Far East (PFEC)
Other Location

COMPLAINT PERTAINS TO:

Faculty

Professor's First/Last Name: 
Course (e.g., ENGL 1301): 

Staff
Other Student
Department/Office
Other:

YOUR Information:

First Name:

Last Name:

Student ID:

Enrolled FROM:

Enrolled TO:

Street Address:

City:

State:

ZIP Code:

Enter at least one phone number (enter NA for others).
Phone Number (Home):

Phone Number (Cell):

Phone Number (Work):

Best Time to Call You:

Email Address:
 

COMPLAINT NARRATIVE/ALLEGATIONS (WHAT HAPPENED and WHEN?)

State your complaint. Be as descriptive as possible; include specific information.

  • * Date of incident
  • * Names of all persons involved
  • * Direct quotes of any conversation/s

STEPS ALREADY TAKEN TO RESOLVE THE ISSUE (WHAT SPECIFIC STEPS HAVE YOU TAKEN TO DATE TO RESOLVE THE ISSUE?)

What steps have you already taken to resolve the problem?

  • * List names of people you have already spoken with
  • * Include times/dates of conversation/s
  • * Include direct quotes of any conversation/s

DESIRED/EXPECTED COMPLAINT RESOLUTION (WHAT ACTION/S WOULD YOU LIKE TO OCCUR AS A RESULT OF YOUR SUBMITTING THIS COMPLAINT?)

  • * State your desired/expected resolution.
  • * Provide specific action/s you would like to occur as a result of filing this complaint.

I understand that submission of this form serves as my signature and certify that the contents being submitted are true and accurate.