Page 11 - Branford Academy of Hair & Cosmotology

Branford Academy of Hair & Cosmetology 203.315.2985

Student Grievance Form

NAME_________________________________
ADDRESS_______________________________________

SOCIAL SECURITY
#_________________________TELEPHONE________________________________

1. Please provide a one or two sentence description of your complaint.
____________________________________________________________________________________
___
____________________________________________________________________________________
___
____________________________________________________________________________________
___

2. Please describe the nature of your complaint in full detail indicating what happened, when the event
occurred and who was involved. If additional space is needed, use the reverse side.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

3. Indicate when and with whom you have already spoken regarding this grievance and what attempts
have been made toward resolution.
____________________________________________________________________________________
___
____________________________________________________________________________________
___
____________________________________________________________________________________
___

4. Indicate what specific resolution you are seeking or recommending.
____________________________________________________________________________________
___
____________________________________________________________________________________
___
____________________________________________________________________________________
___
____________________________________________________________________________________
___

I hereby certify that the statements made pertaining to my complaint are truthful and accurate.

11