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: *

Month Day Year
Date
Name: *

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

Academic Department Grade Dispute Schedule Issue Faculty Advisor Reinstatement
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: *
Enter the message as it's shown: *
Should be Empty: