Grievance Report
Form A
DATE:
_______________
TO:
Dr. Brock Kelley, President Lurleen B. Wallace Community College 1000 Dannelly Blvd., P. O. Box 1418 Andalusia, Alabama 36420
FROM:
_____________________________________________________________
ADDRESS: (home)____________________________________________________
______________________________________________________
SUBJECT: ALLEGED VIOLATION
DESCRIPTION OF ALLEGED VIOLATION:
On__________________________,_______, my Civil Rights, in my estimation, were violated in the following manner:
Signature: ______________________________________ ___________
289
www.lbwcc.edu
2022-23 College Catalog and Student Handbook
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