School of Medicine Student Complaint Form

COMPLAINT INFORMATION FOR CURRENT SCHOOL OF MEDICINE 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, first review the School of Medicine Complaint policy and then complete the form below. Please fill the form completely. You must sign the form. Submit complaints to the Office of Student and Academic Affairs, School of Medicine. 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 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
Date
Date Format: MM slash DD slash YYYY
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