Complaint Resolution Log Form

     Please answer all questions.

  1. Name of Complainant


  2. ID Number (if any):                 3. Complainant Cell Phone  4. Complainant E-mail


  5. Please Select One. What is this complaint about?


  6. Other Complaint Area.  Please describe:


  7. Complaint Description (including staff or faculty member name)


  8.  Describe Complaint Resolution


  9.  Date of Resolution:          10. Name of Personnel Responsible:


11. Complainant Notification Date: