LSU Student Grievance Report Form

Reporter's Information

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Your full name:

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use capital letters

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Urgency of this report(Required):

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If this is an Emergency, call LSU Police at 225-578-3231

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties (PLEASE INCLUDE YOUR INFORMATION AND ANY INVOLVED PARTIES)

Name or Organization

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Reason for Report and Description of Incident

Below are categories that may correspond to this incident, please indicate the relevant section that pertains to the incident.

General University Complaint

Complaint about a faculty member Complaint about a staff member Complaint about a University Department

You must make at least one selection.

Description / Narrative Please describe in as much detail as possible the specific words, phrases and interactions associated with the situation. If the individual was loud or disruptive, indicate behaviors associated with the disruption, and describe any injury or damage to person(s) or property. Include name(s) of campus personnel you contacted and actions taken, if any. This field is required.

Supporting Documentation

Please provide an additional supporting documentation to substantiate your report. This can include reports, assignments, syllabus, emails, or any other documents. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Reporter's Information

Involved Parties (PLEASE INCLUDE YOUR INFORMATION AND ANY INVOLVED PARTIES)

Reason for Report and Description of Incident

Supporting Documentation

Submission