Department of Chemistry Student Complaint Form

Please be sure to speak to the individual in question before filling out this form.
You must complete the entire form. Incomplete or unclear forms will be returned to you.
Make sure to attach copies of any documentation concerning your complaint.

This information will be given to the appropriate individual. Please allow two working days for contact regarding your complaint.

Your Information

Your Name

Your CSU ID

Your Telephone Number

Your Email

What is the best way to contact you?
TelephoneEmail

Course Information

Course Title

Instructor Name

Course Section Number Day/Time

Briefly state the nature of your complaint

Have you talked with the individual with whom you have the complaint?
NoYes (see below)

If yes, please state date, time of contact and response received (please include date of response as well)

Has matter been submitted to another entity? Yes or no (If “Yes,” give name and address)

How can this be resolved? What would you like to see happen to resolve this issue?

Attach copies of any documentation concerning your complaint

In order to resolve your complaint, we may send a copy of this form to the person about whom you are complaining. May we include your identifying information to this person? (If no, we will remove your identifying information before sending a copy. If you choose to remain anonymous, please note that the department may not be able to help resolve your complaint as effectively as we might if this information were known.)

Yes, my identifying information may be used.No, I wish to remain anonymous.

Colorado State University

College of Natural Sciences

Department of Chemistry Student Complaint Form

Your Information