Student Complaint Form
To file a complaint, Please complete and fill out this form completely regarding about your complaint. Academia Medical Institute strives to provide a supportive environment and respects the rights of all students. It is the School’s practice to fairly and objectively address the concerns of any complainant in an attempt to equitably resolve his/her grievance. The Campus Director and the Program Administrator will resolve your complaint once it is received in writing.
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Email *
Date of the Incident: *
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Student Name: *
Best Phon Number to contact you: *
Email Address: *
Do you want to remain Anonymous? *
Who is your complaint against? *
Student Status: *
Expected Date of Graduation: *
Details of Complaint *
Please provide details of your complaint. Include dates, persons, and any pertinent information to resolve your complaint. Use Additional lines if needed.
Have you attempted to resolve this issues with instructor/institution?
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What is your desired outcome? Use additional pages if needed.
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