Effective Date: 11/4/14 Policy Statement: Use of the Formal Student Complaint Form LMU seeks to address written student complaints when brought to administrative attention. The University encourages students who have a legitimate concern to participate in the formal complaint process. This form is used to document and track the institution’s forthright attempts to address appropriately filed Formal Student Complaints. For proper processing, all information must be completed and delivered to the Dean of Students Office in DAR 218 Students are encouraged to use the informal complaint process prior to filing a formal student complaint. Student Contact Information Last Name First Name
Street Address Middle/Maiden Name
City State
Zip Code
LMU ID Number LMU E‐Mail Address
Telephone Number
Term and Last Year Attended
Resident Commuter
Complaint Information Area of the College involved in the Complaint:
Academic policy/procedure Administration Student Services Facilities Instructor Other If this complaint involves an instructor, please complete the information below. Instructor Name: Course Name & Number: Semester: Effective Date: 11/4/14 Please describe how you have attempted to resolve this issue through other means: With whom have you spoken When? What was the outcome? (College Official): Please explain below the circumstances of this formal complaint. (Be specific in explaining your concerns. Include dates and names of individuals who may be involved. Please attach any supporting documentation or additional information you think is relevant to this complaint.) Why are you pursuing the formal complaint process? What do you hope to achieve through the formal complaint process? Student Signature: ______________________________ Date: __________________________________ INTERNAL USE ONLY Date Received:_________________ Forwarded To: _________________________________ Decision: ____________________________________________________________________
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Rationale: ___________________________________________________________________ ____________________________________________________________________________ Signature: __________________________ Date Closed:_______________________