DSS Complaint Form

Western Michigan University and Disability Services for Students are committed to a policy of fair treatment of their students in their relationships with fellow students, faculty, staff, and administrators. Student complaints may be submitted anonymously. However, only when individuals provide their contact information can a resolution be provided to the complainant. Anonymous complaints may also be submitted through related topic procedures listed in Section 6 of the Policy on Student Complaint Tracking and Reporting.

Students are encouraged to seek an informal resolution of the matter directly with the other party when possible. For matters where a resolution is not reached and you believe a policy has not been followed within Disability Services for Students, please complete this form.

Reporting a disability concern

To report an incident of bias, harassment, discrimination or retaliation related to a disability or accommodation, please use Institutional Equity`s Disability Concern Form.

Have you attempted to resolve the problem with the party directly responsible for it? *

Yes, and the resolution provided was not fair, reasonable, or satisfactory

No

I am not comfortable resolving this problem directly

I don't know who is responsible for solving this problem

Name *

First, Middle, Last

WIN *

WMU identification number

Email *

Phone Number *

I am a student registered with Disability Services for Students *

Yes

No

Date on which the event or issue occurred or began: *

Describe your complaint in detail. Include the names of person(s) involved, location(s), and any additional relevant dates. If this complaint is against specific person(s), please list their name and title.

What attempts have you or others made to resolve the complaint? State who was contacted and what transpired.

Why do you think this complaint was unable to be resolved by prior attempts?

What resolution do you feel is fair or equitable?

Are there any units (departments, offices, programs) that are, or you think should be, involved with this complaint?

Is there any additional information you wish to provide or any person(s) you do not want to be told of your complaint?

(Please know that it can be difficult to resolve complaints if involved persons cannot be asked to explain or respond to your complaint. Retaliation of any kind is strictly prohibited and should be reported.)

Attachments

Are there any relevant documents you would like to attach?
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit tar zip.

Certification: *

I agree

By checking this box, 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 appropriate WMU officials for purposes of investigation and response.

Leave this field blank