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Student Complaint Resolution Form for Academic Issues
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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
*
Date Format: MM slash DD slash YYYY
School/College of the course or employee the complaint relates to
*
Choose One
College of Arts and Sciences
Robert B. Willumstad School of Business
School of Professional and Continuing Studies
Honors College
School of Social Work
Ruth S. Ammon School of Education
College of Nursing and Public Health
Derner School of Psychology
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.
For further information, please contact:
Executive Director of Academic Services
Nexus Building, Room 145
e –
oasr@adelphi.edu
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