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Student Complaint Form

Please refer to the Student Complaints Policy before filling out this form. This form is to be used to submit a formal complaint students have been unable to satisfactorily resolve with the faculty, staff, students or others involved.
Name *

First Name Last Name
Date *

- Month - Day Year
Date

Address *

Email *
Phone *
First date on which the events or issues occurred

- Month - Day Year
Date
Name(s) of the person(s) involved
Please describe your complaint in detail. Include the names of persons, locations, and dates involved. If this complaint is against specific person(s), please list their names and titles.
What attempts have you made to resolve this complaint up to now? Please state who you contacted and what transpired.
Why do you think the complaint was not able to be resolved in your prior attempts?
What resolution would you consider fair? What resolution do you seek?
Any other information you want to provide?
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hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to CSU officials for purposes of investigation and response. *

I hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to CSU officials for purposes of investigation and response.
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Student Complaint Form