Submit this fully completed form. Call us at 770-423-6310 for assistance, or e-mail us.

I. Personal Information

Full Name:
Affiliation with KSU:
Email Address:
Home Address:
KSU ID#
Day Phone#
Have you communicated with any department on campus previously regarding this complaint?
If yes, please provide the name, date, position and contact information of the individual contacted along with the outcome proposed.

II. Your Complaint:
Please describe the issue giving rise to your complaint in as much detail as possible. Include any places, dates and/or times you can recall.


I verify by my checking the box below that I understand That to the best of my knowledge, the information I have presented is complete and accurate. I also understand that this matter will be researched based on the information provided and a response will be provided as soon as possible. I Agree

We thank you for your time and we will get in touch with you as soon as possible.