Tuesday, May 21, 2013
Program Integrity Complaint Form
Student Complaint Form
Add TCSG Institution; affiliated program, institute or center; or other name
If former student, last day of attendance at Institution
Date grievance or complaint was filed with Institution, if any:
Details of Complaint:
Include pertinent dates and college officials (administrators, advisors, faculty) that are involved or that you spoke with. See above under "Instructions and Filing Process" for other necessary information. If you have supporting documentation (correspondence, documents, emails, etc.) which will help others to understand the event you describe and substantiate your allegations, please submit it in electronic form as email attachments to: firstname.lastname@example.org. Include "Complaint" in the subject line
What resolution or outcome are you seeking in filing this complaint?
Other Organization Complaint Submitted To
Status of Complaint:
Contact Person Phone:
Contact Person Email:
In order for this complaint to be processed
Please read and affirm all of the following
I hereby attest that the above information is true and accurate to the best of my knowledge.
I will provide additional information and supporting documentation upon request.
I hereby authorize TCSG and/or any of its representatives to disclose the information submitted to the college against which the complaint is filed.
I understand that TCSG may dismiss the complaint if an investigation determines that the complaint is without merit
I understand that TCSG may Refer the complaint to another agency, review board, or other authorized body, as appropriate and necessary.
Enter the code shown above in the box below
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