SurveyMonkey Powered Online Survey

Student Complaint Form

BEFORE PROCEEDING, PLEASE VERIFY THAT

You have exhausted all available grievance procedures established by the institution; and

You are not satisfied with the resolution provided by the institution and are contacting SCHEV as a last resort in the grievance process.

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* 1. Please enter your first and last name

First Name

Last Name

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* 2. Address

Street Address 1

Street Address 2

City and State

Zip Code

Country

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* 3. Home Phone including area code

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* 4. Cell Phone including area code

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* 5. Work Phone including area code

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* 6. Email Address

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* 7. How do you prefer we contact you?

Home phone

Cell phone

Work phone

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* 8. School or Institution Name

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* 9. School Address

School Street Address 1

School Street Address 2

School City, State

School Zip

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* 10. Name of Your Academic Program

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* 11. Degree Level

Diploma

Associate

Baccalaureate

Masters

Doctoral

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* 12. Program Start Date

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* 13. Program End Date

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* 14. Current Status

Currently Attending

Graduated

Terminated/Withdrawn

Other (please specify)

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* 15. Is your student complaint related to a student loan? If not, please proceed to Question 20.

Yes