Class Complaint Form Please note that this form is for students to file a complaint about an instructor. Students wishing to file a grade grievance should consult the Current Students Page on the LAVC website. Question Title * 1. Prior to filing this complaint, students are required to first meet with instructor and then that instructor's department chair. Have you done so? Yes (If so, indicate the name of the department chair and the date of your meeting in the space below. This will be confirmed by the Dean's Office prior to contacting you.) No Dates of Meetings with Faculty Member, Chair Question Title * 2. Your Full Name Question Title * 3. Your Student ID Number: Question Title * 4. Please provide your phone number: Question Title * 5. Please provide your email. Question Title * 6. Please provide the name of the department, class, and/or instructor that is the subject of your complaint. Question Title * 7. Please provide a detailed description of your complaint. If it is an incident, please include the date, time and place as well as any witnesses who were present. Question Title * 8. What action or remedy do you request for your complaint? Thank you for completing this form. You will be contacted within ten working days. Done