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Student Complaint Assistance Form

First Name:
Last Name:
Clarke Email:
Phone Number:
Street Address:
City:
State:
Zip Code:
Person(s), department(s), or office(s)
involved in the complant or appeal:
Semester and year of the incident:
Describe the events that prompted
your complaint or appeal:
Explain any attempts to settle the situation with the person(s),
department(s), or office(s) involved in the complaint:
 

 

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