Complaint - Formal Complaint Resolution

Student Formal Complaint Form

Important: This form is only for student complaints.
Employee concerns should be submitted through the HR i-safe incident reporting site. Patient complaints should be directed to UAMS Patient Relations at 501-296-1039 or by email

Date of Incident

Report Anonymously

Yes No

Last Name

First Name

Email Address

Phone Number (###-###-####)

Your Status

Location of Incident

Faculty or Staff Involved

Have you tried to resolve?

Yes No

How did you attempt to resolve?

Describe the incident:

If reported anonymously, please indicate if you want the complaint to be addressed by the college/department.

Documents

Important: This form is only for student complaints. Patient complaints should be directed to Patient Relations. Employee complaints should be directed to HR.

I confirm this is a student complaint and not a patient or employee complaint.