Non-instructional/General Complaint
Full Name
First Name
Last Name
Student ID
E-mail
example@example.com
Home phone
Format: (000) 000-0000.
Cell phone
Format: (000) 000-0000.
Date of incident that prompted this complaint
*
-
Month
-
Day
Year
Date Picker Icon
Individual and/or department involved
Description of incident
*
What are your primary concerns/issues?
Have you shared your concerns with the reported indvidual or department?
*
Yes
No
Have you attempted to work with them to resolve the concerns/issues?
*
Yes
No
Would you like to propose a resolution?
*
Yes
No
Describe your proposed resolution.
Submit
Should be Empty: