86-200-2
Oglala Lakota College
Informal Student Complaint Form (Exhibit)
(Created May 2012)
Center: _____________________ Date: _____________________
Nature of complaint: _____________________________________________
______________________________________________________________
______________________________________________________________
Concerning (who/what): __________________________________________
______________________________________________________________
______________________________________________________________
Date (s) of occurrence/event/concern: ______________________________
______________________________________________________________
Action taken: ___________________________________________________
______________________________________________________________
By whom: _____________________________________________________
When: ________________________________________________________
Outcome (if known): _____________________________________________
______________________________________________________________
______________________________________________________________
Do you want to take this complaint/concern to the formal grievance process? Y*____ N ____
*If yes, refer to Ruth Cedar Face, EAP/Student Affairs Director at (605) 455-6040
Copies should be placed in every college center, the registrar’s, financial aid, and EAP office.
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