EmailMeForm
Student Complaint Form
The student complaint form is used to submit a grievance for any issue or concern you would like to be reviewed based upon the Shaw University Grievance/ Student Complaint Policy.
Name
*
First
Last
Email
*
Student ID Number
*
Submission Date
*
MM
/
DD
/
YYYY
Phone
*
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###
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####
Major
*
Advisor Name
Semester
Select all that apply
2018-2019 Spring Semester
2019-2020 Fall Semester
2019-2020 Spring Semester
2019-2020 Summer Session I
2018-2019 Summer Session I
2018-2019 Summer Session II
Pertinent Information
Please provide as much detail as possible in this section. Any information you may provide may assist in resolving your issue/concern.
Name(s) involved
Name (s) involved
Please provide names of all involved in your concern /issue.
Date(s) of incident(s):
*
Date of incident(s)
Please enter the date of the incident.
Please indicate the type of complaint:
Select all that apply
IT Services
Maintenance
Student Activities
Other
Instructor
Custodial Services
Student Services
Chapel
Disciplinary Action
Non- Academic
Food Services
Financial Aid
Grades
Discrimination
Library
Classroom
Health Services
Housing
Personal Records
Sexual Harrassment
Mailroom
Safety and Security
Student
Provide a statement that briefly and clearly outlines the nature of your complaint.
*
What remedy or corrective action are you requesting?
*
