Student Concerns and Greivances : Chemistry & Biochemistry : 黑料吃瓜

Name (first, last) *

黑料吃瓜 E-mail: *

Phone Number: *

0/10

黑料吃瓜 ID (including A): *

Course & Section Number: *

N/A if not applicable to your situation.

0/10

Concern/Complaint about: *

Faculty Member

Grades

IA (Student Instructional Assistant)

Staff Member

Other Department Employee

Was this in regards to:

An Exam

Lack of Communication/Replies

Office Hours

Other

Please provide their first and last name *

Please provide the faculty's first and last name *

When did the incident occur? *

Do you work for this individual? *

Yes

No

Was there other individuals involved with this incident? *

Yes

No

If yes, please provide their names and contact information if available.

Is this concern ongoing? *

Yes

No

Please describe the incident in detail: *

Would you like to be contacted for follow-up regarding this matter? *

Yes

No

What is the best method of contact for follow-up communication? *

Are you requesting confidentiality to the extent possible?

Yes, please don't use my name when contacting the person of intrest.

No, you may use my name when contacting the individual involved; however, I do not wish to be contacted further regarding this matter after submitting this form.

Is there any other additional information you believe is important for us to know?

Attach Communications to Instructors or any relevant documentation *

By submitting this form, you acknowledge that the information provided may be shared with appropriate university officials as necessary to review, investigate, and respond to the reported concern. 黑料吃瓜 will make reasonable efforts to maintain privacy consistent with applicable laws and university policies. Reports involving immediate safety concerns should be directed to the University Police Department, and reports involving sexual misconduct should be directed to the Title IX Office. *

Yes, I acknowledge and this acts as my digital signature.