Student Complaint and Grievance Form

Grievance or Complaint Infomation

Your Name:

Your Student ID Number:

Your Telephone Number:

Your Student Email Address:

Email address must be of a valid format.

Type of Complaint(Required):

This field is required.

Date of incident(Required):

This field is required.

Approximate time of incident:

Location of the incident(Required):

This field is required.

Party against whom you are filing a complaint/grievance or witnesses to the incident

Please provide as much information below as possible.

Select the "Add Another Party" box below to list each person involved in the matter, or to list witnesses to the incident.

Name of the other party (select

Select Role

Grievance or Complaint Information

Please provide a summary of your complaint, grievance, or concern. Provide as much detail as possible. IMPORTANT: If you are filing grievance for discrimination, please specify why you feel that you are experiencing discriminatory behavior.(Required) This field is required.

Specify what, if any, steps you have taken to resolve the matter. This field is required.

What would you consider to be an appropriate outcome or resolution to your complaint/grievance?(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

Grievance or Complaint Infomation

Party against whom you are filing a complaint/grievance or witnesses to the incident

Grievance or Complaint Information

Supporting Documentation

Submission