.

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* 1. Select one:

Questions

Complaint

Feedback & suggestions

Other

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* 2. Please describe your situation, complaint or concern:

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* 3. Please describe any action you have taken to address the complaint or concern:

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* 4. Please describe your desired outcome:

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* 5. If you would like a response to your complaint, please complete the following:

First Name:

Last Name:

Email:

Phone Number:

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* 6. Affiliation:

Student

Staff

Faculty

Other (please specify)