<p> ACADEMIC AFFAIRS STUDENT COMPLAINT REPORT/RESOLUTION FORM Office of the Registrar</p><p>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.”</p><p>If you prefer to make an anonymous complaint, you may request the complaint be filed on your behalf by your SGA representative. </p><p>PART A – STUDENT COMPLAINT REPORT: Date Filed______</p><p>Student Name ______ID#______</p><p>Detailed Description of Complaint: ______</p><p>Student’s Desired Outcome: ______</p><p>PART B – STUDENT COMPLAINT RESOLUTION: Date Resolved______Part B is to be completed by the employee</p><p>Complaint Category (per Guidelines): ______</p><p>Investigated/Resolved by______</p><p>Detailed Description of Resolution and Improvement/Modification Implemented, if applicable:</p><p>______</p><p>______</p><p>1</p>