Student Ombudsperson Intake Form

Student Ombudsperson Intake Form
Before completing this form, please read the website to learn about our services. If your situation applies, please proceed to complete the intake form. Our office will contact you to schedule a meeting upon submission of this form.
Date:*

MonthDayYear
Date
Name:*

First NameLast Name
Dawg Tag:*
Email:*
example@example.com
Class Standing:*
Major:
I am having difficulty with (check all that apply):*

Academic DepartmentGrade DisputeSchedule IssueFacultyAdvisorReinstatementOther
In the space below, briefly describe the nature of your issue. Please include as much detail as possible:*
How were you referred to the Student Ombudsperson's Office?
How did you find out about the Ombudsperson Services?
What action would you like to take?

Do you want to schedule an appointment to discuss your complaint?Do you want to document your complaint with our office?
Signature:*
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Should be Empty: