Student Complaint Form

First Name(*)
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Middle Initial(*)
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Last Name(*)
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Local Phone (000-0000)
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Cell Phone (000-000-0000)
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Blazer ID(*)
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Email(*)
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Please mark the appropriate box:(*)

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Incident Date 00/00/00(*)
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Time
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Location
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Staff person(s) you wish to register a complaint against (give full name)(*)
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Please describe incident in as much detail as possible(*)
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Relief or resolution desired
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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 and Professional Development to discuss the conflict or complaint of services.

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