Multicultural Affairs for Students' Student Complaint Form

Multicultural Affairs for Students

Multicultural Affairs for Students' Student Complaint Form

��ϲʹ��ֱ�� and Multicultural Affairs for Students are committed to a policy of fair treatment of their students in their relationships with fellow students, faculty, staff, and administrators. Please refer to the Policy on Student Complaints found in the A-Z Directory of University Policies.

Students are encouraged to seek an informal resolution of the matter directly with the other party when possible. For matters where a resolution is not reached and you believe a policy has not been followed within Multicultural Affairs for Students, please complete this form. Submitted forms will go directly to our director.

Complaints may be submitted anonymously; however, unless you include your contact information, we will be unable to investigate your complaint or respond back to you regarding the subject matter.

First name (as enrolled)

Preferred name

Middle initial

Last name

Relationship to ��ϲʹ��ֱ�� (please select all that apply)

current ��ϲʹ��ֱ�� student

former ��ϲʹ��ֱ�� student

prospective ��ϲʹ��ֱ�� student

��ϲʹ��ֱ�� graduate student

��ϲʹ��ֱ�� undergraduate student

Other

Term and year last attended

Email address

Phone number (with area code)

Address

City, State

Zip code

Complaint description (summary)

Date on which the event or issue occurred or began:

Describe your complaint in detail. Include the names of person(s) involved, location(s), and any additional relevant dates. If this complaint is against a specific person, please list their name and title.

What attempts have you or others made to resolve the complain? State who was contacted and what transpired.

Why do you think this complaint was unable to be resolved by prior attempts?

What resolution do you feel is fair or equitable?

Is there any additional information you wish to provide or any person(s) you do not want to be told of your complaint? (Please know that it can be difficult to resolve complaints if involved persons cannot be asked to explain or respond to your complaint. Retaliation of any kind is strictly prohibited and should be reported.)

If relevant, please include any supporting documentation as an attachment.

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml, avi, mov, mp3, ogg, wav.

Electronic signature

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 the appropriate ��ϲʹ��ֱ�� officials for purposes of investigation and response.

Today's date

Multicultural Affairs for Students
��ϲʹ��ֱ��
1903 W Michigan Ave
Kalamazoo MI 49008-5233 USA
Phone: (269) 387-4420
Fax: (269) 387-3390

Location
2260 Ellsworth Hall, Mail Stop 5233

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Multicultural Affairs for Students

Multicultural Affairs for Students' Student Complaint Form

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