CCU Student Grievance Form
Cornerstone Christian University
Student Complaint Form (Formal Grievance)
Student Information
- Full legal name:____________________________________________________
- CCU ID number:___________________________________________________
- Mailing address:____________________________________________________
- City, state, ZIP:_____________________________________________________
- Preferred email:_____________________________________________________
- Phone number:______________________________________________________
- Preferred contact method: ☐ Email ☐ Phone ☐ U.S. Mail
- Program/major:______________________________________________________
Complaint Information
- Date of incident:______________________________________________________
- Name(s) of person(s) involved:___________________________________________
- Department or office involved:__________________________________________ Location of incident:__________________________________________________
- Course number, if applicable:__________________________________________
Statement of Grievance
Please describe your complaint in detail. Include names, dates, locations, and what happened.
Prior Resolution Attempts
What attempts have you made to resolve this complaint so far? Include the names of people you contacted and the outcome.
Reason for Appeal
Why do you believe the complaint was not resolved satisfactorily?
Requested Resolution
What resolution would you consider fair?
Additional Information
Any other information you want to provide:
Supporting Documents
Attach copies of any documents that support your complaint. CCU’s published form allows additional documents to be submitted and notes that original documents should not be sent.
Certification
I certify that the information provided above is true and correct to the best of my knowledge and belief.
- Signature: _________________________________________
- Printed name: ______________________________________
- Date: _________________________________________________
Submission note
CCU’s published grievance form states that complaints may be submitted online, with additional documents sent to the Registrar, and that anonymous complaints may be filed but cannot be investigated or answered if no contact information is provided. The grievance procedure also indicates that students are expected to attempt resolution with the faculty member first, then the Program Director, then the CCU, and finally the President if needed.