Student Complaint Form

Complaint Information for Currently Enrolled Students

The student is encouraged to address his/her concerns at the earliest possible time and on an informal basis with the program or individual involved. To file a formal complaint, complete the form below. Please fill the form completely. You must sign the form. Submit complaints to the Office of the Associate Dean, School of Graduate Studies and Research. You may file a written complaint without fear of retaliation unless the complaint is filed without basis or with the intent to harm a member of the of the Meharry Medical College community. You may withdraw your complaint in writing at any time. The School may use the information you provide below to contact you.

Nature of Complaint*
- Curriculum
- Environment
- Professor
- Technology
- Testing
- Other
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Status
- Current Student
- Student on Official Leave of Absence
Provide details of your complaint
Describe how you have already attempted to resolve the complaint with parties involved
How would you like to see the complaint resolved?
Witness(es) to the event
(if none, please type "none")
Signature and Date
FOR INTERNAL USE ONLY
Findings
Proposal for Resolution
Signature of Associate Dean and Date

Student Complaint Form

Complaint Information for Currently Enrolled Students

FOR INTERNAL USE ONLY