Academic Affairs Complaint

Use this form for student complaints regarding:

faculty conduct in an academic setting or academic concerns other than grades
problems with an academic department or academic resource area, except grade appeals

* Complete this form if all informal attempts to resolve the situation were unsuccessful.

Student Information

First Name

Last Name

EMPL ID #

Semester

Phone Number

Complaint Type

Choose a type of complaint:

Faculty conduct in an academic setting or academic concerns other than grades
Academic department office or academic resource area

Complaint about faculty conduct or academic concerns

Course / Section

Professor's Name

Did you meet with:

Professor: Yes No Comment / Outcome
Department / Chairperson: Yes No Comment / Outcome
Dean / Dean's Assistant: Yes No Comment / Outcome

Complaint about an academic department office or academic resource area

Please check all that apply:

Learning Center
Library

Instructional Technology
Student Evaluation of Teaching
Tutoring

Did you meet with the Chair / Director / Coordinator?

Yes

Comment / Outcome

Nature of Incident / Complaint

* Note: Once this form is submitted, you will be contacted within 3-5 business days, to confirm receipt of form and inform you of further actions.