Student Complaint Form

1.   Personal Information

Please refer to the Student Complaint Reporting Policy before submitting this form. This form is to be used to submit a formal complaint students have been unable to satisfactorily resolve with the faculty, staff, students or others involved.  This form is to only be submitted by students.  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, Southern University will be unable to investigate your complaint or respond back to you regarding the matter.

2.  Information about your complaint:

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. 

What resolution would you consider fair? What resolution do you seek? 

Why do you think the complaint was not able to be resolved in your prior attempts?   

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). 

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