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SARA Online Student Complaint Form

Please submit this form only if the institution involved is listed on the following link: http://nc-sara.org/states/GA

Note: this complaint form is applicable to students who attend either a public or private (not-for-profit or for-profit) with its principal campus or central administrative unit domiciled in Georgia.

Complainant Information

(*Indicates Required Information)

*Last Name

*First Name

Middle Name

*Street Address

*City

*State

*Zip

*Phone (day)
(evening)
(mobile)

*Email

Concerning Institution

*Name of Institution

*Institution Address (Street, City, State, ZIP Code)

*Institution Phone Number

*Date of Last Attendance or of Incident:

Explain Outcome

Please explain the desired outcome you expect regarding your complaint:

Complaint Information

Have you followed the institutions appeals/or complaint process to resolve your complaint(s)?

Note: the student must have exhausted the institution's complaint and/or appeal process before GNPEC will attempt to help the student establish any possible resolution with the institution.

Complaint Circumstances:

Explain the circumstances that led to your complaint. Be as specific as you can about your concerns and include all the information relevant to your complaint.

*Describe your efforts to resolve this complaint with the institution. Be as specific as you can, including dates, institutional staff with whom you spoke to regarding your complaint, and the school’s response. Please include all information relevant to the complaint. (Upload any supporting documenatation. Acceptable formats: .pdf, .doc, .docx, .odt, .txt, .jpeg, .png, .gif, .jpg).

Resolution Efforts:

Have you filed this complaint with any other organization?

If complaint was filed, please identify the organization(s) and the outcome.

Explain Outcome:

Verification of Complainant and Consent

GA-SARA will use the information you provide as part of its efforts to resolve your complaint. By submitting this complaint, you give consent to the GA-SARA to contact the institution(s) on your behalf to gather information that may be needed to review your complaint. Your consent includes referring complaints to another organization with jurisdiction and authority over the issue.

*By submitting this form, I agree that the information given in this complaint is true and accurate to the best of my knowledge, and I agree that I will provide any additional requested information or respond to questions from GA-SARA related to the review of my complaint. I understand that if I fail to provide requested information or respond to questions, GA-SARA may dismiss my complaint.

Signature
Date

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