General Complaint Form

Reporter's Information

Whenever possible, we encourage that incidents are resolved directly with the staff or department involved. Often a complaint can be resolved in this way. However, if an informal approach is neither successful or advisable, General Complaint Form should be submitted.

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(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:

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Exact room number

Involved Parties

Please fill in the information you can provide about all of the individuals involved (including yourself). For non-students, please list a Drivers License or State ID number in the block labeled SID. If the DL or state ID is from a state other than Michigan, please begin the ID with the state abbreviation. (ex. Ohio=OH).

Name or Organization

Gender

Role

Student ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

This form should be submitted immediately. This generally ensures the availability of all parties involved in the complaint. When completing the Complaint Form, the reporter is expected to provide detailed responses to all of the following questions as it relates to the complaint:

Please provide a detailed description of your concern/complaint using specific concise, objective language.(Required) This field is required.

What have you done to resolve the situation? Include details of the people/offices contacted and the method of contact.(Required) This field is required.

What is the outcome you are requesting?(Required) This field is required.

What is the best way to contact you regarding your complaint?(Required) This field is required.

Supporting Documentation

Attach any supporting documents. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

Select from the list, any that you would like sent a copy of your initial form.

Student Association Ombudsman

Email me a copy of this report

Reporter's Information

Involved Parties

Questions

Supporting Documentation

Select copy recipients

Submission