Distance Education Student Complaint Form

This form should only be completed by students who wish to file a complaint about an online course or instructor. The Office of Distance and Continuing Education staff will review the complaint and follow up with the respective school, department, instructor, and student to resolve the issue or concern.

Date Event Occurred
Student's First Name
Student's Last Name
Student's ID Number
Course Name and Course Number (Online)
Name of Instructor
Identify the Department	Department of Accounting Department of Art Department of Biology Department of Business Administration Department of Chemistry, Geology & Physics Department of Education Department of Health & Physical Education Department of History & Political Science Department of Language, Literature & Communication Department of Mathematics & Computer Science Department of Music Department of Pharmacy & Health Professions Department of Psychology Department of Social Sciences Department of Technology
Describe the issue or concern
Have you talked with the staff or the instructor regarding your concern?	Select one No Yes
If yes, please describe the outcome.
Have you spoken to the chair of the department?	Select one No Yes
If yes, please describe the outcome.
Have you spoken to the dean of the school?	Select one No Yes
If yes, please describe the outcome.
Do you have any witness (student or instructors) to support your complaint?	Select one No Yes
Student Information
Street Address
City
State
Zip Code
Home Phone
Cell Phone
ECSU email address
What's the best time to be contacted?	Select One 8:00AM-10:00AM 10:00AM-12:00PM 12:00PM-2:00PM 2:00PM-5:00PM
What's the best way to be contacted?	Select one Home Phone Cell Phone Email Address Other
Other
When addressing my concern	Select one You may use my name You may use my name only after the end of the term You may not use my name
How did you find out about this process?