Student Complaint Form
  1. Student Filing the Complaint*
    Please type your Name.
  2. Student Contact Email*
    Invalid email address.
  3. Student Contact Phone Number(s)
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  4. Date Complaint Filed*
    Please select the date.
  5. Do You Request Confidentiality?
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  6. Nature of Complaint*
    Please type your College ID#.
  7. i.e. Harassment, Cleanliness of Facility, Grading Policies, Employee Conduct.
  8. Date(s) Incident Ocurred*
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  9. Summarize Your Complaint*
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  10. Be sure to identify individuals or department(s) involved in the complaint.
  11. I Wish to Register an Official Complaint with Copiah‐Lincoln Community College
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  12. Please Enter the Code Shown
    Please Enter the Code Shown
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Wesson | Natchez | Simpson
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