JM University Student Grievances
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Date
*
-
Month
-
Day
Year
Date
Please state any concerns and/or suggestions that you may have. Please include as much information as you can.
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: