Student Complaint Form

This form can be used by students to file a complaint regarding faculty in the academic setting(s), regarding other employees, contractors or vendors, or regarding student services or other University services.

Who is making the complaint?

First Name *

First Name

Last Name

CWID *

Phone *

Email *

Status*

Undergrad Grad

Campus/Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Complaint Information

Date(s) on which the event(s) or issue(s) occurred *

Dobbs Ferry*

Dobbs Ferry Bronx Manhattan Online

Name(s) of the person(s) involved *

Where did this complaint take place? *

Provide Class Name, CRN, School

Department

Please describe other location

Please describe your complaint in detail. Include the names of persons, locations, and dates involved. If this complaint is against specific person(s), please list their names and titles. (Attach a separate page if needed.) *

Please attach additional information

No File Chosen

File uploads may not work on some mobile devices.

What attempts have you made to resolve this complaint up to now? Please state who you contacted and what transpired. *

Why do you think the complaint was not able to be resolved in your prior attempts? *

What resolution would you consider fair? What resolution do you seek? *

Is there any person who you do NOT want to be told of your complaint? *

I hereby certify that the above information is true and correct to the best of my knowledge and belief. I grant permission for this complaint to be forwarded to Mercy University officials for purposes of investigation and response.*

Yes No

I agree to provide such other or supplemental information that may be requested.

Receive Text*

Yes No