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Complaint Resolution Form

Questions/Concerns/Complaints

* required

*Date Initiated:

*Name of Student:

Student Phone #:

Student Email:

Student ID:

*Caller / Complainant:

*Caller Phone #:

*Caller Email:

Relationship to Student:

Student Classification

Major:

Residence Hall

*Nature of Question/Complaint:

If you would like to be contacted by the Ombudsman, please submit your phone number.