Wallace Community College - Dothan

WALLACE COMMUNITY COLLEGE - DOTHAN

(Campus Location)

SEXUAL MISCONDUCT GRIEVANCE FORM C

TO: Chancellor Alabama Community College System FROM: Student Number:

PART I. NOTICE OF APPEAL TO CHANCELLOR

Nature of Grievance being appealed:

Appeal Statement(s): This is an appeal to the Chancellor for a review of the President’s (or Designee’s) Response to Complainant’s appeal submitted on Grievance Appeal Form B (attached hereto). A copy of the initial grievance report (Form A) is also attached. Grievance Form C, noting an appeal to the Chancellor must be received within 15 calendar days of receipt of the President’s report or the right to appeal to the Chancellor will be forfeited.

Complainant

Distribution: President Title IX Coordinator

PART III. CHANCELLOR’S REPORT

Home Address:

FROM: Chancellor Alabama Community College System

Date Appeal Received:

Date of Report:

Response to Appeal: (Attach additional pages if necessary.)

Chancellor

Distribution: Complainant President Title IX Coordinator 02/19/2016