Student Complaint Form - Fort Scott Community College

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FSCC Student Complaint Form

Confidential Incident Report Form By completing this form, I understand that Fort Scott Community College may contact me for additional information and to determine the next steps. I acknowledge that this form is confidential and secure. Please note: Title IX complaints will follow additional policies and procedures in accordance with college guidelines. File Upload Disclaimer: Any files uploaded through this form may be reviewed by authorized personnel as part of the investigation process.

Name(Required)

First Last

Please provide an email that you can be reached at.(Required)

Please provide a phone number that you can be reached at(Required)

Pease select the type of complaint you are filing (select all that apply)(Required)

Academic (matters related to academic issues, including faculty concerns, classroom content and environment, etc.)

Student/ Non-Academic (behavior in violation of FSCC’s code of conduct including but not limited to: academic dishonesty, alcohol and controlled substances, bullying, or other disruptive behavior. Note: this category is NOT intended to include reports of student sexual misconduct or student discrimination, harassment or retaliation.)

Crawford County CampusStudent Discrimination, harassment, or retaliation (prohibited conduct by students engaging in harassment or discrimination based on race, gender, national origin, disability, age, religion, marital status, veteran status, sexual orientation, genetics or any other legally protected class. This category also includes reports of retaliation against any person for filing or providing information related to a complaint of prohibited conduct or against any person engaging in otherwise protected activity. Note: Discrimination, harassment, retaliation by employees or third-parties maybe reported directly to the Human Resources Director)

Student Pregnancy and/or Parenting (FSCC is committed to creating an inclusive, accessible, and equitable learning environment for pregnant and parenting students. Title IX of the Education Amendments of 1972 prohibits discrimination based on sex in education programs or activities including academic, education, extracurricular, athletic, and other programs or activities in schools. This prohibition includes discrimination against pregnant and parenting students. The purpose of this form is to assist the college in determining whether, or to what extent, a pregnancy adjustment can be granted.

Student Sexual Misconduct (Sexual Misconduct by students including non-consensual or unwelcome sexual advances, requests for sexual favors or any other verbal or physical conduct of a sexual or gender-based nature, including sexual assault, rape, dating violence, domestic violence, stalking, sexual harassment, sexual intimidation and hostile work/academic environment. Note: Sexual misconduct by employees or third-parties may be reported directly to the Director of Human Resources, or the Title IX Coordinator.

Provide a brief description of the complaint as well as any attempt you have made to resolve the concern.(Required)

Who is the complaint against(Required)

Is there anyone else we should reach out to regarding this complaint/concern?(Required)

Please provide any details or documentation that verify you attempted to resolve this concern as the lowest level possible. Please upload files in PDF format.

Max. file size: 50 MB.

By signing (typing) my name below, I verify that I have attempted to resolve this concern at the lowest levels (except Title IX complaints) and have documented information showing these attempts. Additionally, if I am a parent filing a third party complaint, I verify my student is incapable of filing this complaint and I have direct documented evidence of the concern (not hearsay from my student)(Required)

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