Grievance Form – Burrell College of Osteopathic Medicine Forms

Please list the College policy or procedure that has been violated:*

I would like to submit my complaint anonymously.*

Yes
No

Anonymous reports significantly restrict the ability of the administration to investigate and come to resolution. Complainants are encouraged to identify themselves to aid in the investigative and resolution process. The College ensures all such grievances are strictly confidential.

Name

First Last

Email

Phone

Date of Grievance

Location:

Individual(s) Involved:

Efforts to Settle Matter Informally:

Remedy Sought:

Please provide a description of the complaint:

Relevant Files:

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