<p> Route this form to: U Wide Form: UM 1698 Student Academic Complaint Rev: 11/25/08</p><p>This form supports the Administrative Procedure: Conflict Resolution Process for Student Academic Complaints: Twin Cities</p><p>Student Filing Petition Name: College/Program: Contact Information: </p><p>Factual Basis of Complaint Describe action being questioned and include all relevant dates.</p><p>University Rule, Policy or Practice Identify the specific University rule, policy, or practice that is believed to have been violated.</p><p>Person(s) Responsible for the Action (If Known)</p><p>Proposed Remedy Identify a remedy that is within the authority of the University to grant under the Conflict Resolution Process for Student Academic Complaints: Twin Cities.</p><p>Signature: ______Date: </p><p>The University of Minnesota is an equal opportunity educator & employer.  2008 by the Regents of the University of Minnesota.</p>