Complaint Form UW System University * Required(Select One From Below)UW-Eau ClaireUW-Green BayUW-La CrosseUW-MadisonUW-MilwaukeeUW-OshkoshUW-ParksideUW-PlattevilleUW-River FallsUW-Stevens PointUW-StoutUW-SuperiorUW-WhitewaterComplainant Name * Required First Last Complainant Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Complainant Phone * RequiredComplainant Email * Required Enter Email Confirm Email If you are not the complainant, but are submitting this form on their behalf, please also answer the following:I am the complainantI am not the complainantOther - Name First Last Other - PhoneOther - Email Self Description: * RequiredCurrent StudentFormer StudentProspective StudentParentAttorneyState OfficialIf you are a Former Student, please provide your last date of attendance: MM DD YYYY Date complaint was filed with the University: * Required MM DD YYYY Name of person at university who handled the complaint (if known) First Last Email address of person at university who handled the complaint (if known) Status of Complaint * RequiredUnresolvedIn ProgressDetails of Complaint: * RequiredPlease include all names, dates, locations pertinent to our understanding of the situation.Resolution: * RequiredWhat resolution or outcome are you seeking in the filing of this complaint?In order for this complaint to be processed, please read and affirm (by clicking the check box) all of the following: * Required I hereby attest that the above information is true and accurate to the best of my knowledge. I will provide additional information and supporting documentation upon request. I hereby authorize the UW System and/or any of its representatives, to disclose the information submitted to the campus/campus officials against which the complaint is filed. I understand that UW System may dismiss the complaint if an investigation determines that the complaint is without merit. I hereby affirm that I have executed this form either on my own behalf OR on behalf of the complainant for the specific purposes I describe. Captcha