Student Complaint Form

(Please use the Title IX Complaint form for sexual harassment and assault complaints)

Kentucky Wesleyan College considers student feedback essential to achieving our mission. Please review the Student Complaint and Appeals Policy to understand your options before completing this form.

Name*
First Last
Date
MM slash DD slash YYYY
Phone
Student Preferred Email*
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I am writing to make a formal complaint about (Whom or a brief description of what your complaint is about). I have already taken the initial steps to resolve this by speaking to (Name of the person you spoke to informally). However up to this point, the issue has not been resolved and so I am taking this opportunity to raise my concerns to you. Below I have outlined my complaint and have provided this description and documentation to support my case.
In the Next Section it is important to CLEARLY EXPLAIN:
What your complaint is about, i.e. What occurred? Who was involved? Dates and times if possible. If the issue concerns financial accounts be sure to include the posting date, academic term and dollar amount of the specific item(s) of concern and why you have a complaint or request for adjustment of the item.
How this affected you? Academically and/or personally
What steps you have taken to resolve the problem?
What outcome would you like to see? What do you feel needs to occur for the problem to be resolved?
I have attached the following document as evidence of my complaint;
Drop files here or

Max. file size: 50 MB.
List documents. These could include emails, exams, grades, sections from the academic bulletin or student handbook, doctor’s/hospital statements, letter from counselor, external scholarship agency, letters from minister/pastors/priest/work supervisor, that will support your concern or request.
E-Signature*
*
- I understand that checking this box verifies my legal signature above.