Concern Submission Form

I am submitting this form on behalf of: *

myself

my son/daughter

3rd party/admin only

other other

Initials *

Your First Name *

Your Last Name *

Phone Number *

If submitting this form on behalf of another person, please enter that person's name below

First Name

Last Name

Person named above is a: *

Email Address *

Campus: (Please select the campus with which you have a concern)

If not affiliated with a campus, please explain.

0/100 words

Have you brought your concern to the attention of the appropriate parties on your campus? *

yes

no

n/a

Most concerns can and should be handled at the campus level. You are encouraged to take that route first. If there is a reason why you feel that is not possible, please explain.

0/250 words

Please list the names and titles of the people you have corresponded with on your campus regarding this issue.

Concern relates to (select the most applicable categories): *

Please explain, in 250 words or less, your concern. We understand you may have more to share. Once we review this submission we can direct your concern to the appropriate party for further discussion if needed. *

0/250 words

Attachment. Please attach any relevant documents, 20MB limit

Admin note