Edward Waters University

Student Complaint 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. Please complete all fields so your complaint may be directed to the proper college representatives.

Please Note: Complaints may be submitted anonymously; however, unless you include your contact information, EWU will be unable to investigate your complaint or respond back to you regarding the subject matter.

Student Information
Do you wish to remain anonymous?*

YesNo
Name*

First NameLast Name
Student ID#*
EWU Student Email*
All formal communication must take place using your EWU-issued Email Address.
Phone Number*
Please enter a valid phone number.
Major/Minor*
Advisor Name
Academic Classification*
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 EWU officials for purposes of investigation and response.

Please choose what type of complaint you wish to file:

AcademicAthleticCampus SafetyFacilitiesHousingStudentTechnology

Date of Incident/Grievance

MonthDayYear
Date
What best describes your complaint?

Complaint Against an Individual (Faculty/Staff/Student)Grade DisputeOther
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 include who you have contacted and what transpired.
Why do you think the complaint was not able to be resolved in your prior attempts?

What resolution would you consider fair? What resolution do you seek?
Is there any additional information that you would like 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.
If you have any files or documentation to support your complaint, please include them below

Cancelof
Should be Empty:

Student Complaint Form