Sign Up For Email/Text Updates

First Name:
Last Name:
E-mail Address:
Sign up for the following:

Mobile Phone:

WVNCC Formal Complaint

  • Case #_____________________

  • This form may be completed by any member of the West Virginia Northern Community College community who has experienced or otherwise become aware of an incident that may constitute a violation of a school policy.  Please complete the form to the best of your ability. Non-Discrimination Statement and associated policies, procedures and forms (including disabilities and Title IX complaint information).

  • Preferred Method of Contact:

  • WVNCC Affiliation:

  • Incident Date:

  • Incident Location (select all that apply):

  • Type of Incident:

  • Protected Class(es) Basis for Report:

  • WVNCC Affiliation:

  • WVNCC Affiliation:

  • WVNCC Affiliation:

  • WVNCC Affiliation:

  • Supportive Measures Requested:

  • Accommodation:

  • Resolution Requested:

  • Signature: _________________________________________________________  Date: ______________

    Received by:  ______________________________________________________  Date: ______________

* = Required