Complaint Form

Identify your relationship with Lenoir Community College:













Have you brought this matter to the attention of any other department(s) at LCC? List the name(s) and department(s) of all other persons with whom you have discussed this matter.

Complaint Type: Select all that apply:

Describe your complaint and include relevant dates that the alleged behavior occurred. Please summarize below.

Is the behavior ongoing? If so, when is the last time it occurred?

Name of person or persons you believe discriminated against you and why you have contact with them (i.e. Supervisor, co-worker, faculty, customer):

Name of witness(es) and your relationship to them. Please include contact information if known.

Additional Information:

Do you certify that the above information is correct?


Please leave this field empty.