Student Complaint Form Section 1: Personal Information Please refer to the Student Complaints Policy before filling out this form. This form is to be used to submit a formal complaint after students have been unable to satisfactorily resolve with the faculty, staff, students or others involved. The Student Resolution Center provides conflict resolution services to assist students experiencing conflicts with faculty, staff, roommates, friends, family, and others. Please complete all fields so your complaint may be directed to the proper university officials. Complaints may be submitted anonymously; however, unless you include your contact information, CSU will be unable to investigate your complaint or respond back to you regarding the subject matter.Which best describes the nature of your complaint?(Required)Academic: UndergraduateAcademic: Graduate/DVMNon-AcademicYour full legal name (as enrolled) First Middle Last Preferred Name First Middle Last Undergraduate Major or Graduate Degree Program Expected Year of Graduation Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email PhonePreferred method of contact Email Phone U.S. Mail CSU ID(Required) Section 2: Information about your complaintFirst date on which the events or issues occurred MM slash DD slash YYYY Name(s) of the person(s) involved Please describe your complaint in detail. Include the names of persons, locations, and dates involved. If this complaint is against specific person(s), please list their names and titles.What attempts have you made to resolve this complaint up to now? Please state who you contacted and what transpired.Why do you think the complaint was not able to be resolved in your prior attempts?What resolution do you seek?Any other information you want to provide?For instance, is there any person who you do NOT want to be told of your complaint? (Keep in mind that it may be difficult to resolve if those involved cannot be asked to explain or respond). NOTE: RETALIATION AGAINST A STUDENT FOR MAKING A COMPLAINT IS ABSOLUTELY PROHIBITED, AND WILL BE CONSIDERED A SERIOUS VIOLATION OF PROFESSIONAL RESPONSIBILITY. File If attachments are necessary, please include as a .jpg or .pdf Drop files here or Select files Accepted file types: jpg, pdf, Max. file size: 31 MB. (Required) I hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to CSU officials for purposes of investigation and response.