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Student Complaint Form
Please complete the following form.
Date event occurred *
Student's first name *
Student's last name *
CNM Student ID No. *
Check one *

Course Name and Course Number
Name of Instructor *
Identify the category of your complaint (check all that apply)  

Describe the issue or concern (be specific regarging who, what, when, and where)  
Have you talked with staff or the instructor regarding your concern? (if yes, please describe the outcome)
Student contact information
Street address *
City *
State *
Zip code *
Phone *
my CNM Email Address *
When address my concern (check one)

How did you find out about this process?
Today's date *
Please PRINT THIS FORM before pressing the Submit button as confirmation

CNM will not allow any form of retaliation against individuals who file a complaint to CNM management, or who cooperate in the investigation of such reports. To the extent possible, the confidentiality of the reports will be maintained.