State University Student Complaint Form

Today's Date

First Name

Last Name

Address 1

City

State/Province/Region

Zip/Postal Code

Email

Are/Were you a student of a state university?

Yes

No

Please provide your student ID

University

Date of the action that is the subject of your complaint

Have you exhausted available institutional processes

Yes

No

Provide names and titles of university officials contacted

Have you contacted other agencies

Yes

No

If YES, name the agency/agencies

Have you contacted an attorney

Yes

No

If YES, provide the name of your attorney

Have you initiated court action

Yes

No

Detail your complaint. Include action(s) and outcome(s)

What resolution are you seeking

By entering my name below, I am agreeing to the following statements

I hereby swear under penalty of perjury that the information contained in this compliant is true and correct to the best of my knowledge.
I consent to the information contained in this complaint being shared with the above named institution.
If the Board office determines that the complaint alleges a violation of laws that another state agency is charged with enforcing, I authorize the Board office to forward the complaint to the appropriate enforcing entity.
I understand that this complaint and other documents generated or obtained to address this complaint may be subject to the Kansas Open Records Act.

Type your full, legal name