Office of Accessibility Services: Grievance Report
Student ID
*
Name
*
First Name
Last Name
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
BRCTC Email
*
example@example.com
What is/are your preferred methods of communication?
*
Phone
Email
Text
Name of Instructor
*
Class:
*
Date of Report
*
In your own words, explain in detail the issue that occured:
*
Explain the steps you have taken to attempt to resolve this issue with your instructor to date:
*
I understand that submission of this form initiates a conversation between the OAS and my instructor regarding my issue.
*
Agreed
I understand that details regarding my grievance will be shared with the instructor.
*
Agreed
I understand that the OAS will make every effort to mediate the issue to result in a positive outcome.
*
Agreed
Signature
*
Please verify that you are human
*
Submit
Should be Empty: