Complainant Information All fields are required. Please note that the Coordinating Commission for Postsecondary Education cannot act on anonymous complaints. First Name of complainant: Last Name of complainant: Affiliation with the college or university named below: Current student Former student Parent or guardian of current/former student (for students under 19) Other Address: City: State: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoU.S. Minor Outlying IslandsVirgin IslandsArmed Forces Americas (AA)Armed Forces Europe (AE)Armed Forces Pacific (AP)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon Zip Code: Preferred Phone Number: Email Address: How do you prefer to be contacted: Phone Email No preference If Commission staff members need to contact you via phone, may they leave a phone message or voicemail? Yes No College/University Information Name of institution: City located: State located: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoU.S. Minor Outlying IslandsVirgin IslandsArmed Forces Americas (AA)Armed Forces Europe (AE)Armed Forces Pacific (AP)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon Degree level and major/concentration (e.g. B.S. in Accounting; Certificate in Welding) of the affected student: Dates of attendance at institution: Start Date: End Date: Complaint Information Have you gone through the institution's formal complaint process? Yes No If you answered "Yes", please submit documentation showing that you have exhausted your appeals at the institutional level. Please see below on how to send in such documents. If you answered "No", please explain in your detailed complaint description below why you were unable to complete the complaint process. Note that the Commission will normally only address complaints after a student has exhausted his/her appeals at the college or university level. Please describe your complaint in detail, including the names of any college or university faculty or staff you spoke to about the complaint: Please give titles and contact information for the individuals (if any) you mentioned above: How would you like your complaint to be addressed? (Please note that the Commission cannot, by law, review complaints related to course grades, academic sanctions or discipline/conduct matters.) Will you be submitting additional documentation (such as e-mails from school officials, transcripts, course syllabi, contracts, brochures, catalogs and/or tuition bills) that substantiates your complaint? Yes No Please send copies of any documents that support your above complaint and/or show that you have gone through your institution's complaint procedure to: Kathleen.Fimple@Nebraska.gov, fax them to (402) 471-2886, upload files below, or mail them to: Nebraska's Coordinating Commission for Postsecondary Education ATTN: Complaints P.O. Box 95005 Lincoln, NE 68509-5005 By submitting this form, I affirm that I am a current or former student of the institution named above or the parent or guardian of a current or former student of that institution who is currently under age 19 and/or under my legal guardianship. I agree to allow the Coordinating Commission for Postsecondary Education to submit a copy of my complaint and supporting materials to the above-named institution for a response, as well as to the state agency responsible for complaints in the state in which the institution is located or in which I live if not Nebraska. I further authorize the institution to transmit student records related to me or to the individual(s) under my guardianship affected by the institution's actions to the Commission for review. I understand that I may have to submit an information release form to the institution. Additionally, I recognize that my complaint may be subject to Nebraska's public records law as defined in Nebraska Revised Statutes §§ 84-712 through 84-712.09. I certify that the information I have provided to the Commission is complete, true, and correct to the best of my knowledge and belief. Upload documents below: Total file size for all files cannot exceed 17MB. File Upload (pdf, xls, xlsx, doc, docx, jpg, png, gif, tiff, txt) File Upload (pdf, xls, xlsx, doc, docx, jpg, png, gif, tiff, txt)
