Student Complaint Form for Online Courses

Student Complaint Form for Online Courses
To initiate a complaint about an online course, a student must complete and submit this form.

If you have any questions regarding the form or the status of a submitted complaint/ inquiry, please contact the Director of Student Success: Dr. Joanna Hersey.
Your Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Incident Information
Date(s) of incident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Course Information
File Uploads
Do you have any documents you wish to submit to support the facts set forth in the form (photos, video, email, and other supporting documents)? Please attach.

Cancelof
Should be Empty:

Your Information