Student Complaint Form

Background Information

Student's full name:

Student's phone number:

Student's email address:

Email address must be of a valid format.

Complaint is about(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

People involved in complaint, if applicable

Please list the individuals involved in the complaint. Please leave this information blank if the complaint does not involve a person.

Name or Organization

Select Gender

Select Role

Questions

Explain the circumstances of this complaint. Be specific in explaining the concerns; include dates and the names of individuals who may be involved.(Required) This field is required.

In what way(s) has the student attempted to address or resolve this complaint prior to reporting, if any? This field is required.

What would the student consider to be an acceptable resolution to the complaint?(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

People involved in complaint, if applicable

Questions

Supporting Documentation

Submission