Student Complaint Record: Academic Student Complaint Record: Academic Policy No. 1903 This form is designed to be completed by the Department Chair, Program Director, and/or Center Director. Its purpose is to provide a means for documenting student complaints in a manner that allows them to be systematically addressed.Student Name* First Last Student ID #*Student Email* Enter Email Confirm Email Nature of complaint*Check all that apply. Inappropriate faculty content, instruction, materials, and/or assessment Inappropriate faculty conduct Faculty incompetence in oral or written communication Inequities in assignments Scheduling of class or exams at other than authorized and published times Routinely canceling classes or dismissing students early Deviation from syllabus Failure to provide disability accommodations Inadequate or inappropriate advising Failure to communicate in a reasonable time frame Unfair or inappropriate grading practices University policies/procedures Other (provide specific details below) Other complaint description*Provide a narrative to summarize the complaint.*Describe action(s) already taken by the student to resolve the matter (if applicable).Note: If the nature of the complaint makes it inappropriate for the student to meet with the Department Chair, Program Director, and/or Center Director, then the student should meet with the Director of Student Success or the Dean of the appropriate college.Student Signature*By signing this worksheet, I certify that all the information reported on this form is complete and correct.