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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. https://www.wvncc.edu/other-information/35 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: ______________



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