Whitlowe R. Green College of Education

Candidate Inquiry/ Complaint Form

Date

2.	Personal Information

First Name	Last Name
Permanent Home Address	City
ST	Zip
Phone Number	Email
Department / Office

3.	Current Mailing Address (if different from above):

Street		City
ST		Zip
Primary Phone		Alternate Phone
Email

4.	How would you prefer we contact you?

Phone

E-mail

5.	Inquiry / Complaint Details

The information you provide will be used in efforts to resolve your inquiry/complaint and will be shared with the school. By submitting this complaint, you are giving the Prairie View A&M University Whitlowe R. Green College of Education permission to contact individuals to discuss a possible resolution to your inquiry/complaint.

Describe your inquiry/complaint in detail? Specify any pertinent dates, staff you dealt with, etc.

Attach any documentation which will help describe the problem and substantiate you allegations. (i.e. emails correspondences, forms, etc.)