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2006-2007 Student Handbook - University of the Incarnate Word

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Formal Conference Documentation Form(For a <strong>Student</strong> Complaint about an Instructor’s Decision)Part I The student completes this part prior to <strong>the</strong> meeting with <strong>the</strong> instructor.<strong>Student</strong> Name: ____________________________ ID #: ________________________UIW email: ____________________Phone/cell: (____) ___________________Address: _____________________________________________________________________________________________________________________________________________________________Instructor’s Name: ____________________________UIW extension #: ___________Issue (completed by <strong>the</strong> student prior to <strong>the</strong> conference):____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________………………………………………………………………………………………………………………By signature I acknowledge that I have met with <strong>the</strong> above named student to discuss thisissue. I am/am not (circle one) providing written comments. (Comments must besubmitted to your dean within three days <strong>of</strong> this meeting.)Signature <strong>of</strong> Instructor: _______________________________ Date: ________________………………………………………………………………………………………………………………Part 2The student, after <strong>the</strong> meeting, describes whe<strong>the</strong>r resolution <strong>of</strong> <strong>the</strong> complaint wasreached or not:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Signature <strong>of</strong> <strong>Student</strong>: _________________________________ Date: ________________Whe<strong>the</strong>r <strong>the</strong>re is resolution or not, <strong>the</strong> student delivers this form in a sealed envelope to<strong>the</strong> Dean <strong>of</strong> <strong>the</strong> college/school in which <strong>the</strong> instructor resides.If resolution was not reached and <strong>the</strong> student wishes to appeal <strong>the</strong> instructor’s decision,<strong>the</strong>n <strong>the</strong> student requests from <strong>the</strong> Dean’s Office <strong>the</strong> Appeal Form for <strong>Student</strong>Complaints about Faculty Decisions completes it and returns to <strong>the</strong> Dean’s Office withinthree days.cc: <strong>Student</strong>Instructor97

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