Urgent Resolution Request
Before filling out this request, we ask that you have already made at least 2 attempts to resolve the issue directly with your instructor and have waited an adequate amount of time for their reply. Typical instructor response time is 24-48 hours after each attempt.
Contact information
Note: Retaliation against a student for making a complaint is absolutely prohibited and will be considered a serious violation of professional responsibility.
Full name (as enrolled) *
Your answer
Student Gmail address e.g. (jdoe6@student. umpqua. edu) *
Your answer
Phone (optional)
Your answer
Preferred method of contact *
Information about the issue
Class CRN or description *
Your answer
Instructor's name *
Your answer
How did you contact the instructor regarding the issue? *
Required
When did you first contact the instructor? *
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/
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/
YYYY
When did you last contact the instructor? *
MM
/
DD
/
YYYY
What type of issue are you experiencing? *
Required
Please describe the issue *
Your answer
Resolution
What resolution do you consider to be fair? *
Your answer
Please provide any additional information
Your answer
*
Required
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