Ombuds Intake Form

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Ombuds Intake Form

Thank you for reaching out to our Ombudsman for support today. Please fill out this form for general data collection and as a way to catalog how we can better assist you. Please start by providing the best email to contact you.
*Your information here is confidential until you provide written consent, and even then only to the parties you consent to.

Email *

LAST Name *

FIRST Name *

If you are reaching out on behalf of someone else (say, a student) please provide their first and last name as well).

What is your relationship to OSA? *

Student

Guardian/Parent

Staff

Alumni

Community Member

What best describes the relationship of the subjects of your concern?

Policy (what is OSAs written language for X)

Practice (how an OSA policy is being enforced in practice)

Process (How you would go about engaging with OSA given a specific concern)

People (OSA related people's conduct given the 3 above)

Other:

What is the category of your concern? (You may check all that apply). *

Identity related (race, ethnicity, religion, etc).

Gender/sex related (gender, sex, sexuality, etc).

Academic related (grading, iep/504 accommodations, etc).

Safety related (bullying, violence, ADA accomodations, security, etc).

Other:

Required

Describe your concern in the space below. *

If you would like your concern to be shared with an OSA admin, please name them below to be looped in. (If not, leave blank).

*Otherwise, please assume that this intake is strictly confidential between you and the Ombudsman.

If there is another way that is best to contact you other than email, provide below. (If not, leave blank).

Send me a copy of my responses.

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