Student Complaint Form BEFORE PROCEEDING, PLEASE VERIFY THATYou have exhausted all available grievance procedures established by the institution; andYou are not satisfied with the resolution provided by the institution and are contacting SCHEV as a last resort in the grievance process. OK Question Title * 1. Please enter your first and last name First Name Last Name OK Question Title * 2. Address Street Address 1 Street Address 2 City and State Zip Code Country OK Question Title * 3. Home Phone including area code OK Question Title * 4. Cell Phone including area code OK Question Title * 5. Work Phone including area code OK Question Title * 6. Email Address OK Question Title * 7. How do you prefer we contact you? Home phone Cell phone Work phone Email OK Question Title * 8. School or Institution Name OK Question Title * 9. School Address School Street Address 1 School Street Address 2 School City, State School Zip OK Question Title * 10. Name of Your Academic Program OK Question Title * 11. Degree Level Diploma Associate Baccalaureate Masters Doctoral OK Question Title * 12. Program Start Date OK Question Title * 13. Program End Date OK Question Title * 14. Current Status Currently Attending Graduated Terminated/Withdrawn Other (please specify) OK Question Title * 15. Is your student complaint related to a student loan? If not, please proceed to Question 20. Yes No OK NEXT
