Los Angeles City College

Admissions & Records

Name:
Student ID Number:
Address:
Phone Number:	( ) - Second three digits Last four digits
Phone Number Type:	Home Work Cell
Email Address:

Date of Event:

The date the incident occurred.

Department or Staff Involved:

Admissions and Records
Financial Aid
Other

Description of Complaint:

Please include the names and departments of any staff members involved in the incident.

Describe Any Effort You Have Made To Resolve The Issue:

What is a Fair Resolution to Your Problem?:

Security code:

Answer the question below:

Is four < than four? (true/false)

Please enter the security code to complete your application.
Please answer with either a number (ex. 7) or with the words “true” or “false”

If you are experiencing issues with the Student Information System (SIS) student portal, you may report your problem by completing this form.

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Monday - Thursday: 8:00 am - 6:30 pm
Friday: 8:00 am - 2:00 pm

Student Services Building, 1st Floor
Los Angeles City College
855 N. Vermont Avenue
Los Angeles, CA 90029

Phone: (323) 953-4000 ext. 2104
Fax: (323) 953-4021