Student Resolution Request Form

Student Resolution Request Form
Before completing the Resolution Center Form, please review the Resolution Center website. The Resolution Center website provides a Student Self-Service & Inquiry Form where students can find solutions for many concerns.
STUDENT INFORMATION
Student Name*

First NameLast Name
Student ID*
Westcliff Email Address*
Phone Number*

Area CodePhone Number
Program
Current Student Status*

Currently EnrolledWithdrawnGraduated
Type of Request*

Student ConcernResolution Appeal

STUDENT CONCERN
Department*
Other*
Have you addressed your concern with the respective department prior to the completion of this form?*

YesNo
Prior to filling out the resolution form, please contact the appropriate department or personnel via email regarding your concern. You can also use the Student Self-Service & Inquiry Form if your concerns are listed there.

If your concern remains unresolved after attempting both of these approaches, kindly proceed with completing this form.
Complaint Department
Date/Time of Incident*

MonthDayYear
Student Resolution Statement*
Please type a detailed description of your concern(s). If your statement does not fit in the space provided below, please upload your statement along with supporting documentations.
Individual(s) Involved
List all individuals involved, including professors, class and date; if relevant
Desired Resolution Outcome*
What outcome do you feel will best address your concern(s) and ensure that you are supported in the achievement of your goals.

TITLE IX VIOLATION
Thank you for contacting us regarding a Title IX incident. We will contact you as soon as possible. Please review the following for additional details regarding Title IX and how students are supported under this regulation.

Title IX Education Amendments of 1972 (Title IX) states:

No person in the United States, shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.

Title IX at Westcliff University (Statement of Non-Discrimination)

Westcliff University (the “University”) does not discriminate in its employment practices or in its educational programs or activities on the basis of sex. Westcliff University also prohibits retaliation against any person opposing discrimination or participating in any discrimination investigation or complaint process internally or externally. Reports of misconduct, questions regarding Title IX, and concerns about non-compliance should be directed to the Title IX Coordinator or the Assistant Secretary of Education within the Office for Civil Rights (OCR). Please see the University’s Title IX policy for additional information including how to make a report and the University’s Grievance Procedure.

If you believe that you have experienced or witnessed Sexual Harassment, discrimination or retaliation, the University encourages you to notify the Title IX Coordinator as soon as possible after the incident.

Title IX Coordinator

The Title IX Coordinator and Title IX Deputy Coordinator are listed below. Individuals should also contact the Title IX Coordinator/Deputy Coordinator regarding the application of Title IX, its implementing regulations, to make a report or file a Formal Complaint or other questions. The Title IX Coordinator/Deputy Coordinator oversees the University’s compliance with Title IX and is also responsible for identifying and addressing any patterns or systematic problems that arise during the review of such complaints.

Title IX Coordinator: April Vuong

17877 Von Karman Ave. Suite #400

Irvine, CA 92614

949-825-5999

titleixcoordinator@westcliff.edu

Deputy Title IX Coordinator: Josh Schoonover

17877 Von Karman Ave. Suite #400

Irvine, CA 92614

949-825-5999

titleixdeputy@westcliff.edu

Any person can report sex discrimination, including Sexual Harassment (whether or not the person reporting is the alleged victim) in person, by mail, telephone, or e-mail, using the contact information listed above for the Title IX Coordinator/Deputy. A report can be made at any time, including during non-business hours. However, responses to reports made outside of business hours, including weekends and holidays, may be delayed.

For more information, please visit https://www.westcliff.edu/life-at-westcliff/student-services/titleix/

RESOLUTION APPEAL
1. Newly available evidence;
2. Potential deviation from official procedures, which could have affected the resolution;
3. Arguable misalignment between the evidence and the resolution; or,
4. Alleged bias of the investigator(s).
Resolution Ticket No.*
States and explains one or more of the four (4) grounds for appeal
Please explain in details for any relevant and/or newly available information or evidence that was not available in resolution request

REPORTER INFORMATION

If you are submitting this report on behalf of another individual, please enter your contact information below.
Reporter Name

First NameLast Name
Reporter Phone Number

Area CodePhone Number
Reporter Email

SUPPORTING DOCUMENTATION
Attach documents/Upload*

Please upload any supporting documentation that you have for this incident.
Cancelof
I hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to Westcliff officials for purposes of investigation and response.
Zendesk Ticket Body
Should be Empty: