Student Complaint Form

First Name(*)
Invalid Input

Middle Initial(*)
Invalid Input

Last Name(*)
Invalid Input

Local Phone (000-0000)
Invalid Input

Cell Phone (000-000-0000)
Invalid Input

Blazer ID(*)
Invalid Input

Email(*)
Invalid Input

Please mark the appropriate box:(*)

Invalid Input

Incident Date 00/00/00(*)
Invalid Input

Time
Invalid Input

Location
Invalid Input

Staff person(s) you wish to register a complaint against (give full name)(*)
Invalid Input

Please describe incident in as much detail as possible(*)
Invalid Input

Relief or resolution desired
Invalid Input

By submitting this form, I understand and accept that: An accused staff person has the right to be notified and provide his or her account of the incident. You are expected to meet with the Director of UAB Career Services to discuss the conflict or complaint of services.

Please type in the following characters:(*)
Invalid Input

UAB News

UAB Career & Professional Development Twitter