Complaint Resolution Log
1. Name of Complainant
2. ID Number (if any):
3. Complainant Cell Phone 4.
5. Please Select One. What is this
Equipment & Supplies
Other Complaint Area. Describe Below.
6. Other Complaint Area. Please describe:
7. Complaint Description
(including staff or faculty member name)
8. Describe Complaint Resolution
9. Date of Resolution:
10. Name of Personnel Responsible:
11. Complainant Notification Date: