Chowan University Student Complaint Form

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Chowan University is committed to providing students with a means for sharing their concerns and officially registering complaints about any academic program, student service, or university process. The Student Complaint Form provides students with an avenue to submit a concern regarding any area on campus for which no other specific process exists. This form is not an appeal form, and, therefore, should NOT be used to submit complaints regarding academic penalties or student disciplinary actions. Students should follow the established appeal process as outlined in the Academic Catalog and Student Handbook. In addition, a student who wishes to file a Title IX complaint should request the Title IX Complaint Form.

Email *

Today's Date *

YYYY

Last Name *

First Name *

Student ID Number *

Email Address *

Cell Number *

Area of Complaint *

Academics, Registrar's Office, Writing Center, Information Technology, Library, Tutoring, Disability Services, or Academic Success

Student Life, Residence Life, Food Services, Campus Ministry, Career Services, Public Safety, or Counseling Services

Business Office, Financial Aid, Housecleaning, Bookstore, or Grounds and Maintenance

Athletics

Other or Don't Know

Describe your complaint in detail. Include date/s of occurrence (be as specific as possible). *

What evidence supports the complaint? How may this be verified? Are there any witnesses who should be interviewed? If yes, list names and contact information. *

What harm has resulted? *

Have you made an attempt to resolve this complaint with the individual and/or office involved? *

Yes

Have you made an attempt to resolve this complaint with the individual and/or office involved? *

Yes

What steps have been taken to remedy this situation Who has been consulted and when? *

What outcome do you hope to achieve after talking to appropriate university officials? *

I understand that information contained in the complaint form will be held confidential to the extent possible. Complaint information may be shared with university officials in order to conduct a thorough investigation. I hereby declare that the information on this form is true, correct, and complete to the best of my knowledge. Please put your full name below. *

A copy of your responses will be emailed to the address you provided.

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