Student Complaint Form

CIA is committed to treating all members of the community equitably and transparently in regard to their personal and professional concerns. Nevertheless, students sometimes feel they have been treated unjustly, and CIA is committed to listening to and acknowledging their complaints. The student complaint policy and procedures have been designed to help ensure that students are aware of the way in which their problems with college policies, programs, services, and/or faculty and staff members can be addressed informally or through a more formal conciliation process when needed.

Each student must be given adequate opportunity to bring problems to the attention of the faculty or staff member with the assurance that those problems will be given due consideration and treatment. This process also exists to inform the faculty or staff member of the details of a complaint and gives them an opportunity to respond in a reasonable manner.

You can choose to submit this form anonymously, however, know it may limit opportunities for possible resolutions between involved parties.

1. Student First Name

2. Student Last Name

3. Student Email This question requires a valid email address.

4. Student Phone Number

5. Student ID (can be found on mycia under personal information)

6. Address

8. Who is this issue pertaining to?

10. What steps, if any, have you taken to resolve the issue?

Space Cell	yes	no
If Academic: Spoke to Professor	If Academic: Spoke to Professor: yes	If Academic: Spoke to Professor: no
If Academic: Spoke to Department Chair	If Academic: Spoke to Department Chair: yes	If Academic: Spoke to Department Chair: no

11. What was the date of this conversation? This question requires a valid date format of MM/DD/YYYY.

calendar

12. If Administrative, Explain the nature of the issue and the steps taken to resolve it. *This question is required.

13. If the issue pertains to something else, explain the nature of the issue and steps taken to resolve it.