Student Complaint Report/Resolution Form

ACADEMIC AFFAIRS STUDENT COMPLAINT REPORT/RESOLUTION FORM Office of the Registrar

This form should be completed if you wish to lodge a formal complaint related to some aspect of the Office of the Registrar’s operations. Please send the completed form from your Old Westbury e-mail address to the Registrar at [email protected] . The subject line should read “Complaint.”

If you prefer to make an anonymous complaint, you may request the complaint be filed on your behalf by your SGA representative.

PART A – STUDENT COMPLAINT REPORT: Date Filed______

Student Name ______ID#______

Detailed Description of Complaint: ______

Student’s Desired Outcome: ______

PART B – STUDENT COMPLAINT RESOLUTION: Date Resolved______Part B is to be completed by the employee

Complaint Category (per Guidelines): ______

Investigated/Resolved by______

Detailed Description of Resolution and Improvement/Modification Implemented, if applicable:

______