Student Complaint Resolution Form for Academic Issues

(Excluding Grade Complaints)

For Student: Please complete the information below. It will be sent to the relevant administrator once you click Submit.

Complaint Date*
School/College of the course or employee the complaint relates to*
Robert B. Willumstad School of Business*
- Undergraduate
- Graduate
School of Professional and Continuing Studies*
- In Person
- Online
School of Social Work*
- Undergraduate
- Graduate
College of Nursing and Public Health*
- Undergraduate
- Graduate
Your Name*
First Last
Your Email Address*
Complaint Subject*
Brief description of the complaint (please feel free to attach additional pages, evidence or information)*
Additional Information
Accepted file types: doc, docx, txt, rtf, pdf.
Allowed file extensions: doc, docx, txt, rtf, pdf
Describe below any steps you have taken to address the situation, and/or what actions you anticipate as next steps.*
Student Signature*
Typing your name here as a signature confirms that the above information is accurate to the best of your knowledge.

Associate Provost for Academic and Student Life
Nexus Building, Room 304
e – oasr@adelphi.edu