Student Dispute Resolution Form

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Student Dispute Resolution Form

Student Dispute Resolution Center Submission Form

Step I of the Grievance Procedure for Student Complaints encourages you to address your concerns first with the individual involved in the complaint (or the direct supervisor of that individual). If that does not provide satisfactory resolution or is impractical, please complete this form.

DO NOT USE THIS FORM FOR THE FOLLOWING: grade appeals, transfer credit appeals, appeals of academic dismissal or appeals of Student Community Standards findings. The Center does not have the authority to review these decisions. Please follow the appropriate procedures for appeals of those decisions as outlined in the Academic Catalog (www.rockies.edu/catalog).

Student, Alumni, Former Student, Prospective Applicant Information

Field with an asterisk * are required fields.

Subject of Complaint (check all that apply):

Complaint Information

Please provide the following information about your complaint:
Date & Time of Incident(s)

Please explain the nature of your complaint. (minimum 100 characters)
(Note: You will have the opportunity to submit documentation supporting your complaint after it has been reviewed.)

Please list the names of the individuals involved in your complaint:

Have you made an attempt to resolve this problem? If yes, please describe those attempts.

Please state the remedy you seek as the outcome of your complaint:

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