Thomas Jefferson University

Student Grievance Form

Student Information





Grievance Category


Describe the Issue


Description of Grievance *

If Policy Violation or Request for an Exception to Policy please indicate the policy here.


Is there any supporting information available?
For example, regarding your grievance, documents, etc?

Please indicate what steps you have taken to address your grievance. 
Check all that apply.

 None taken
 Met with person closest to the issue
 Met with other department member(s) to address the issue
 Have been referred to fill out this form

What do you feel is an appropriate outcome to this grievance?*

By my e-signature I verify this information to be accurate to the best of my knowledge.



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Edison Building
Suite 1120
(215) 503-6335
(215) 503-2787


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