Submit comments, concerns, complaints, and stories related to Intellectual Pluralism

Send this form, hard-copy only, with all accompanying information and documentation, to the Office of the Provost, 114 Jesse Hall.

This form will be reviewed by Dr. Michael Prewitt, Associate Vice Provost and Director of the Office of Student Rights & Responsibilities. He will call you and follow up on the incident.

This form can be completed online, printed and signed or is available in PDF format.

Course Number:	Semester:
Course Name:
Your Name:	Your Student Number:
Your Email Address:	Your Phone Number:
Instructor Name and Department:	Instructor Office # and Building:
Your comment, concern, complaint, story: (Please be as detailed as possible, including quotes from your instructor where applicable. Please attach any supporting documentation.)
Send this form, hard-copy only, with all accompanying information and documentation, to the Office of the Provost, 114 Jesse Hall. This form will be reviewed by Dr. Michael Prewitt, Associate Vice Provost and Director of the Office of Student Rights & Responsibilities. He will call you and follow up on the incident.