Dickinson State University Communication Proficiency Complaint

							                                    Dickinson State University
                 Communication Proficiency Complaint Reporting Form
                        Submit to VP for Academic Affairs or VP for Student Development



Instructor_______________________________ Term___________________ Year________

Course Prefix _________             Course Title__________________________________________

Complaint Information:

Date Filed: _________________

Source of Complaint:

      Student _____        Group of Students _____ Anonymous ____                 Other (e.g., parent) _______

Type of Complaint:

      Oral ____            Written ____

Complaint Reported To:

      Faculty ____         Dept. Chair ____           Dean ____         VP ____           Other ____

Resolution Requested by Complainant:
(Describe how the complaint was investigated, the results of the investigation, and how the complaint was resolved)




Follow-up with Complainant:
(Describe any follow-up with the complainant’s satisfaction with the resolution of the problem)




Complaint Closure:




Vice President for Academic Affairs __________________________________ Date: ________

Vice President for Student Development _______________________________ Date: ________