Student Complaint Form

Name:

Street address:

City, state, zip:

Email:

Daytime phone:

Enrollment status: Current student Former student Prospective student Other

Which institution does your complaint concern?

Does your complaint concern an online course or program?

• Yes
• No

What is the primary issue of your complaint? Consumer protection Licensure of postsecondary institution Quality or curriculum standards Accreditation Online learning Student records Other

If other, please specify.

Describe the nature of the complaint and relevant information.

Have you contacted the institution to resolve?

• Yes
• No

If no, why not?

What resolution are you seeking?

Have you discussed this matter with an attorney?

• Yes
• No