Student Complaint Submission System All complaints are taken seriously and will be reviewed by the appropriate departments responsible for such submissions. You should expect to receive an acknowledgement and follow-up. Imminent Danger Advisory If you believe that you, or another person, are in imminent danger of harm, DO NOT USE THIS FORM. Please contact Public Safety at 718-262-2222 or dial 911 immediately - Public Safety office is located in the Academic Core Building, Room 1M02 Acknowledged False Complaint Advisory Knowing submission of a false complaint through this portal is misconduct and subject to discipline under the Student Conduct Code & applicable collective bargaining agreement. I Acknowledge and confirm First Name Provide your first name Last Name Provide your last name EMPL ID Phone Number to reach you York College E-Mail Address Preferred Method of Contact Phone Email Check this Box if you want to remain anonymous Anonymous Classification Which of the following most closely defines your affiliation to York College? --Please Select--Undergraduate StudentGraduate StudentFacultyStaff Year Classification No value--Please Select--First YearSecond YearThird YearFourth YearOther Academic School No value--Please Select--School of Arts & SciencesSchool of Business & Information SystemsSchool of Health Sciences & Professional Programs Major No value--Please Select--Undeclared majorAccounting BSAnthropology BAArt History BAArt Studio BAAviation Management BSAviation Management CERTBio Technology BSBiology BABiology BSBiology Teacher Educ 1-6 BSBlack Studies BABusiness Adminstration BSChemistry BAChemistry BSChemistry Middle School BSChemistry Teacher Educ 1-6 BSClinical Lab Science/MT BSCommunications Technology BSCommunity Health Education BSComputer Science BSCreole for Professionals CERTCUNY Baccalaureate BACUNY Baccalaureate BSCUNY Permit GraduateCUNY Permit UndergraduateEarth Science /Education 7-12 BSEconomics BAEnglish BAEnglish Teacher 1-6 BAEnv Health Science BSFine Arts BAFrench BAGeology BSGerontological Studies BSHealth Education Pre K-12 BSHealth Promotion Management BSHealth Science BSHistory BAHistory Teacher Educ 1-6 BAInformation Systems Management BSInterdis Std Teacher Ed 1-6 BAInterdisciplinary Studies BAJournalism BAMarketing BSMath Teacher Educ 1-6 BAMath Teacher Educ 7-12 BSMathematics BAMathematics BSMovement Science BSMusic BAMusic Teacher Educ 1-6 BANon Degree GraduateNon Degree UndergraduateNursing BSNursing(RN) BSOccupational Therapy BSMSPharmaceutical Sci & Bus MSPharmaceutical Sciences BSPhilosophy BAPhysical Education Teacher Pre K-12 BSPhysician Assistant BSPhysician Assistant MSPhysics BSPolitcal Science BAPsychology Teacher Educ 1-6 BAPsychologyPublic HealthSocial Work BSSociology BASociology Teacher Educ 1-6 BASpanish BASpanish for Professionals CERTSpanish Teacher 7-12 BASpeech BSSpeech Theatre Arts BA Current Status No value--Please Select--AttendingGraduatedNot AttendingOther Location of Incident Select the main location of where the Incident occurred No value--Please Select--York CollegeQueens EOCOff CampusOther Date of Incident Most recent event Time of Incident Approximate time of recent event (please add AM or PM after time) Subject of Complaint Provide Name(s) of person(s) or write unknown Classification of Subject of Complaint Which of the following most closely defines the subject(s) of complaint affiliation to York College? No value--Please Select--Undergraduate StudentGraduate StudentFacultyStaffUnknown Type of Complaint No value--Please Select--Academic policy/procedureServicesSafetyAdministrationTechnologyStaffFacilitiesInstructorOther Detailed Description Please describe your complaint in detail. Include names of persons, locations, and dates involved. If this complaint is against specific person(s), please list their names and titles. Attempts What attempts have you made to resolve this complaint up to now? Please state who you have contacted and what transpired? (Relate any actions you have already taken to address this concern. For example: spoke with professor, spoke with advisor, contacted the appropriate office, etc.) Desired Resolution What resolution would you consider fair? What resolution do you seek? Other Complaints Have you filed a complaint with any other organization(s) or entity(s) related to this complaint? --Please Select--YesNo Note: If yes, please provide us with the name of the organization(s) and the outcome. Law Enforcement Has this incident been reported to law enforcement? --Please Select--YesNo Campus Security Has this incident been reported to Public Safety? --Please Select--YesNo Additional Information Any other information you want to provide? Attachments If attachments are necessary, please include as a .jpg or .pdf Submission By submitting this complaint you affirm that the above allegation is true to the best of your knowledge, information and belief. I Acknowledge and confirm
