Ombuds Complaint Form
Ombuds Complaint Form
Name
Name
*
Title
First
Last
Suffix
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Canada
Australia
Netherlands
France
Germany
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Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
Gabon
Gambia
Georgia
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Preferred Phone
Preferred Phone
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-
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####
Alternate Phone
Alternate Phone
-
###
-
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Email
*
Time(s) for Preferred Phone
Time(s) for Alternate Phone
Faculty
*
Faculty
AMPD
Education
Environmental and Urban Changes
FGS
Health
Lassonde
LAPS
Osgoode
Schulich
Science
SCS
Status
*
Status
Undergraduate
Graduate
Alumni
Applicant
SCS
Faculty/Staff
Undisclosed/Unknown
Non-Community Member
Enrolment Status
*
Domestic
International
Undisclosed/Unknown
Campus
*
Keele
Glendon
Markham
Type of issue
*
Academic
Administrative
Student life
Health and Wellbeing
Faculty matters
Staff matters
Others
Academic type of issue
*
Academic Integrity
Grade reappraisal
Accomodations
Instructor concern
Class coordination
Why did you contact the Office of the Ombudsperson? Choose all the answers that best apply to the type of support for your situation.
Why did you contact the Office of the Ombudsperson? Choose all the answers that best apply to the type of support for your situation.
Advice and referral
Information and clarification
Specific referral/Informal resolution
Intervention
Document review
What department or office is your question or complaint about? (Please identify by name)
*
Have you attempted to address your concern or complaint with the individual or department/office?
*
Please summarize the matter you are complaining about and include any relevant dates.
*
Summarize what steps you have taken to try and resolve your complaint including any grievance, appeals and/or requests for reconsideration you have submitted and what response you received.
*
If you have received a final decision on an appeal or request for review or reconsideration of your complaint, please indicate what the result was and why you feel this was unfair.
How did you hear about the office?
How did you hear about the office?
Faculty
Staff
Student
Office/Department