STUDENT GRIEVANCE COMPLAINT FORM Please refer to the before filling out this form. This form should be used to document a formal complaint only AFTER you have attempted to resolve the dispute or complaint informally with the other party or parties involved (e.g. by speaking with your instructor, program lead/division director, and/or faculty advisor). The completed form should be submitted to the SOE Office of Student Affairs at or by mail to: Johns Hopkins School of Education Office of Student Affairs 6740 Alexander Bell Drive Columbia, MD 21046 STUDENT INFORMATION Name (Last, First, M.I.): JHU Student ID: Address City State Zip Code Daytime Telephone: Evening Telephone: JHU Email: Academic Program Advisor The following supporting documentation must be included along with this form: Written statement Supporting documents (indicating how they support your grievance) (if applicable) Information for inclusion in your written statement: Please describe the nature of your complaint in detail. If this complaint is against a specific person(s), please list their name(s) and, if an SOE employee(s), their position/title. Indicate the date(s) and location(s) when the event(s) or issue(s) occurred, and any potential witnesses. Describe what attempts you have made so far to resolve this complaint. Please state whom you contacted, when this communication(s) occurred, and what transpired. Finally, what resolution do you seek? I declare that the information provided on this form and in all supporting documents is true, and that I have been unable to informally resolve this matter with the parties involved. Student Signature Date ************************************************************************************************************ OFFICE USE ONLY: Letter Sent to Student Yes No Refer Case to Student Affairs Committee Yes No Vice Dean (or Designee) Signature Date cc: Office of Student Affairs
STUDENT GRIEVANCE COMPLAINT FORM Please refer to the before filling out this form. This form should be used to document a formal complaint only AFTER you have attempted to resolve the dispute or complaint informally with the other party or parties involved (e.g. by speaking with your instructor, program lead/division director, and/or faculty advisor). The completed form should be submitted to the SOE Office of Student Affairs at or by mail to: Johns Hopkins School of Education Office of Student Affairs 6740 Alexander Bell Drive Columbia, MD 21046 STUDENT INFORMATION Name (Last, First, M.I.): JHU Student ID: Address City State Zip Code Daytime Telephone: Evening Telephone: JHU Email: Academic Program Advisor The following supporting documentation must be included along with this form: Written statement Supporting documents (indicating how they support your grievance) (if applicable) Information for inclusion in your written statement: Please describe the nature of your complaint in detail. If this complaint is against a specific person(s), please list their name(s) and, if an SOE employee(s), their position/title. Indicate the date(s) and location(s) when the event(s) or issue(s) occurred, and any potential witnesses. Describe what attempts you have made so far to resolve this complaint. Please state whom you contacted, when this communication(s) occurred, and what transpired. Finally, what resolution do you seek? I declare that the information provided on this form and in all supporting documents is true, and that I have been unable to informally resolve this matter with the parties involved. Student Signature Date ************************************************************************************************************ OFFICE USE ONLY: Letter Sent to Student Yes No Refer Case to Student Affairs Committee Yes No Vice Dean (or Designee) Signature Date cc: Office of Student Affairs
StudentGrievanceForm_July2018.docx