FSS - Feedback Form

Student/Staff/Faculty Feedback Form

FACULTY OF SOCIAL SCIENCES
This form is to be used for the formal submission of feedback by students, administrative staff and or faculty. Please complete all fields so that your feedback may be directed to the relevant University officials. Feedback (e.g. complaints, positive feedback, suggestions) may be submitted anonymously, however, your contact information is needed for the Faculty of Social Sciences to thoroughly investigate and to consider certain matters.
Section 1

Personal Information
Status

StudentAdministrative StaffFaculty
Name

First NameMiddle NameLast Name
Address (Optional)

Street Address

Street Address Line 2

CityState / Province

Country
Email
Phone Number( mobile/home)

Country CodeArea CodePhone Number
Office Number
Student/Administrative/ staff/ Faculty - I.D. #
I.d #
Department / Unit
Staff or Faculty Only!
Major
Students Only!
Expected Year of Graduation
Students Only!
Preferred Method of Contact*

EmailTelephone

Is there any other information you want to provide?(E.g. Person(s) who you do NOT want to be told of your feedback? N.B If your feedback assumes the form of a complaint or specific accusation directed towards other individuals, then it may be difficult to resolve if those involved cannot be asked to explain and or respond).
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Date

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Date
Signature

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Student/Staff/Faculty Feedback Form