Complaint Form - Leech Lake Tribal College

First Name

Last Name

Student ID Number

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Contact Information

Email

Cell Phone Number

Home Phone Number

Preferred Method of Contact:

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Information About Your Complaint

Complaint Category: Please check the box (es) that apply. (If you do not see a category that applies to your complaint, select “Other” and describe the incident in the ALL DETAILS box below)

Academic Disputes

Accounting/Billings

Accommodations

Customer Service

Educational Quality

Privacy

Other

Date of Incident

Place Incident(s) Occurred

First Name of Person Involved

Last Name of Person Involved

Title of Person Involved

Please describe your complaint in detail. Include persons, locations, and dates involved.

What actions have you taken to resolve your complaint? Please include Individuals and when you contacted them.

What Resolution would you consider fair? What Resolution do you seek?

Is there any additional information you'd like to provide?

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Signature

Date Submited

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