Grievance Form Home > Student Services > Student Resources and Forms > Grievance Form Student Complaint Form (Formal Grievance) Step 1 of 2 50% Use this form to submit a formal grievance which you have been unable to satisfactorily resolve with the faculty, staff, students or others involved. Please complete all fields. Sign the form and submit online. Send additional documents to: Calvary Chapel University Attn: Director of Academic Affairs 13848 N Bolivar Dr Sun City, AZ 85351 info@calvarychapeluniversity.edu 954-453-9228 Complaints may be submitted anonymously; however, unless you include your contact information and sign this form, CCU will be unable to investigate your complaint or respond back to you regarding the subject matter. Please retain a copy of your complaint, including any attached materials, for your records. Do not send original documents, they will not be returned. Send copies. Student Grievance Appeals may be submitted to: Calvary Chapel University Board of Governors 13848 N Bolivar Dr Sun City, AZ 85351 info@calvarychapeluniversity.edu 954-453-9228 Your full legal name (as enrolled) First Last Your CCU ID Number Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your preferred Email address Enter Email Confirm Email PhoneYour preferred method of contactEmailPhoneUS MailMajor Section 2: Information About Your ComplaintFirst date on which the events or issues occurred: MM slash DD slash YYYY Name(s) of the persons involved: Please describe your complaint in detail. Include the names of persons, locations, and dates involved. Use additional sheets if you need more space. If this complaint is against specific person(s), please list their names and titles.What attempts have you made to resolve this complaint up to now? Please state who you contacted and what transpired.Why do you think the complaint was not able to be resolved in your prior attempts?What resolution would you consider fair? What resolution do you seek?Any other information you want to provide?Please upload any documents that you would like to include in this complaint Drop files here or Select files Accepted file types: pdf, jpg, doc, docx, Max. file size: 256 MB. You may delete a file by clicking the red x next to the title of the file you have uploadedCertification* I certify the above as true and correct to the best of my knowledge and belief. I do not certify the above as true and correct to the best of my knowledge and belief. I hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to CSU officials for purposes of investigation and response. SignatureDigital Signature -Printed Name Signature Date MM slash DD slash YYYY Complaints may be submitted anonymously; however, unless you include your contact information and sign this form, CCU will be unable to investigate your complaint or respond back to you regarding the subject matter. I do not wish to sign my name and understand that CCU will be unable to investigate this complaint. I certify the above as true and correct to the best of my knowledge and belief. Digital Signature - Printed Name Signature Date MM slash DD slash YYYY Δ
