COMPLAINT FORM

Your complaint is important to us. Please note that this form is for students to file a complaint about an instructor or a class. Once submitted, we will follow up within five (5) business days to your LACCD email account.  This form is NOT for discrimination complaints about an instructor or a class. If you feel like you have been discriminated against by an instructor or during a class, please visit http://www.wlac.edu/Policies/Discrimination.aspx , where you can find out about how to file a discrimination complaint.

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* 1. I am filing a complaint against an instructor or class?

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* 2. In order to resolve your complaint in a timely manner, we need to assess the steps you have taken prior to completing this form.  Have you met with the department chair to discuss your complaint?

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* 3. With which Academic Dean have you discussed your complaint:

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* 4. YOUR FULL NAME:

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* 5. YOUR LACCD STUDENT ID NUMBER:

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* 6. YOUR PHONE NUMBER:

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* 7. YOUR LACCD EMAIL ADDRESS:

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* 8. Name of INSTRUCTOR:

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* 9. Date you met with instructor mm/dd/yy:

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* 10. Name of DIVISION CHAIR:

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* 11. Date you met with Division Chair:

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* 12. Course Title:

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* 13. Section Number:

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* 14. Please provide a detailed description of your complaint.  If it is an incident, please include date, time, and location.  Please list any witnesses.

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* 15. What action do you request for your complaint?

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* 16. Thank you for submitting this complaint about an instructor or a class. As previously stated, this form is not for discrimination complaints about an instructor or a class. If your complaint using this form contains discrimination concerns or issues, the College will contact you about the grievance procedures for discrimination complaints.

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