Indicates required field Student Concern/Complaint Form Your Information First Name Last Name EagleLinks ID# Enter the 7 digit number on your student ID card Student Email Address Student Email Address Your current Coppin State University student email address, ex. AStudent00@student.coppin.edu Confirm email Phone Number Incident Information Date and Time Date and Time: Date Date and Time: Time Location of Incident Include class number and section, if applicable. Witnesses (Names and contact if available) Indicate who the concern involves Student, Professor, Staff Member, Administrator, Other Describe the Concern or Complaint Remedy Requested I hereby declare that the information on this form is true, correct and complete to the best of my knowledge. I understand that any misrepresentation of information may result in disciplinary action as stipulated in the University’s Student Code of Conduct. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit Leave this field blank
