First Name:
University ID:
Are you? Freshman Sophomore Junior Senior Graduate Student
E-mail:
Telephone #: ( ) -
Department in Which Complaint Arose:
Type of Misconduct:: Personal Academic Off-campus
Semester in Which Complaint Arose:
Name of Person(s) Involved: Course Name:
Course Number:
Members Involved in Attempting an Informal Settlement:
Referred By: Nature of Grievance:
Remedy Attempted: