PHSU - Student Complaint

I. Student Information

Enter the student information. If you are not the student, you will be asked for your information

Last Name First Name Middle Name

Address City State Zip Code Telephone Number Email Address

Relationship To Student

II. Details of Complaint

1. Incident Logistics

Program Enrolled Current or Former Student Campus Date of Incident

2. What are the events that led to this complaint?

Drag and drop any supporting documents or files here or click to open the file loading dialog. (max size 10MB)

3. How have you attempted to resolve the complaint with the school?

4. How would you like to see the complaint resolved?

III. Involved Parties

No extra parties involved.

IV. Certification

I hereby certify that I am the named complainant and that the above statements are true. I understand that this complaint and the information provided will be shared with the school.

Student or Representative Date