Revised May 1 - PDF document

1 Revised May 1 Higher Education Complain
Revised May 1 Higher Education Complaint Form The Pennsylvania Depament of Education (PDE) will accept all written and sicomplaints against colleges, universitiend semina The person filing the complaint with PDE mt attest that the following is true: The person has submitted the complaint to PDE in writing using the “Higher (for submission of form or estions) �� &#x/Att;¬he; [/;ott;&#xom ];&#x/Typ; /P; gin; tio;&#xn 00;&#x/Att;¬he; [/;ott;&#xom ];&#x/Typ; /P; gin; tio;&#xn 00;Revised May 2 Higher Education Complaint Form Name Addr e ss 1 Addr e ss 2 City State Zip Code Phone Fax E - mail Program of Study Dates of Attendance Institution Addr e ss 1 Addr e ss 2 City State Zip Code Phone Did you follow the Institution’s grievance procure to resve your complaint? If no, please explain. How did y contact the Institution? Please specify who was contacted and on what date(s), if possible. Phone Call In Person Letter E-mail Other Revised May 3 What outcome did you seek from the Institution? ve you contacted another agency or organization about the matter? If yes, please give name of agency. ve you contacted arney? If yes, please give name of attorney. Describe your complaint in detail. Specify any des, staff y dealt with, monies owed, balances due, etc. Use additional paper if necessary. Attach any documtation ich will help deibe the problem and substantiate your allegations, such as aenrollment contract, correspden with or from the institution, etc. Do not submit ginal documents as they may not be returned. Pursuant to 18 Pa. C.S. 4904(a), and under penty of perjury, I declare the foregoing to be true and correct to the best of my owledge. I also grant PDE peission

2 to release my name and complaint details
to release my name and complaint details to the institution.SIGNA OF COMPLNANT DATE December 2020 3 What outcome did you seek from the Institution? ve you contacted another agency or organization about the matter? No Yes If yes, please give name of agency. ve you contacted arney? No Yes If yes, please give name of attorney. Describe your complaint in detail. Specify any des, staff y dealt with, monies owed, balances due, etc. Use additional paper if necessary. Attach any documtation ich will help deibe the problem and substantiate your allegations, such as aenrollment contract, correspden with or from the institution, etc. Do not submit ginal documents as they may not be returned. Pursuant to 18 Pa. C.S. 4904(a), and under penty of perjury, I declare the foregoing to be true and correct to the best of my owledge. I also grant PDE peission to release my name and complaint details to the institution. SIGNA OF COMPLNANT DATE Revised 20 2 Higher Education Complaint Form Name Addr e ss 1 Addr e ss 2 City State Zip Code Phone Fax E - mail Program of Study Dates of Attendance Institution Addr e ss 1 Addr e ss 2 City State Zip Code Phone Did you follow the Institution’s grievance procure to resve your complaint? No If no, please explain. Yes How did y contact the Institution? Please specify who was contacted and on what date(s), if possible. Phone Call In Person Letter E-mail Other 1 Higher Education Complaint Form The Pennsylvania Depament of Education (PDE) will accept all written and sicomplaints against colleges, universitiend seminaertified to operate in Pennsylvania. The person filing the complaint with PDE mt attest that the following is true: The person has submitted the complaint to PDE in writing using the “Higher Education Complaint Form.” The person has signed the form attesting to the truth and accuracy of the complaint. The person has signed the form to authorize the dis

3 closure of his/her name and concerns. T
closure of his/her name and concerns. The person has submitted evidence to support the allegation against the institution. (Please do not submit original documents as they may not be returned.) The person recognizes that PDE may not be able to process an anonymous complaint. By signing the form, the person acknowledges that PDE may share the complainant’s name and the information provided by the complainant with the institution in order to investigate the complaint. Upon eceiving student omplaintll termine the atter fallwithin its jurisdictionIf preliminarfindingindite violation a higher education institution, PDE shall empt esolve e complaintAll arties will tified f the utcome the nvestigation. PennsylvanRight Know Law (RTKL) provides that records gency elating n-criminal investigationincluding mplaints submitted encyare exempt from disclosuHoweverin vent ffice oOpen cordor court ould etermine that ecordbeing ubmitted anot xempt from disclosurethe epartment uld have disclose em ia RTKrequest imade for he ecords. Submit to:Pennsylvania Department of EducationHarrisburg, PA 17126-03(for submission December 2020 3 What outcome did you seek from the Institution? ve you contacted another agency or organization about the matter? No Yes If yes, please give name of agency. ve you contacted arney? No Yes If yes, please give name of attorney. Describe your complaint in detail. Specify any des, staff y dealt with, monies owed, balances due, etc. Use additional paper if necessary. Attach any documtation ich will help deibe the problem and substantiate your allegations, such as aenrollment contract, correspden with or from the institution, etc. Do not submit ginal documents as they may not be returned. Pursuant to 18 Pa. C.S. 4904(a), and under penty of perjury, I declare the foregoing to be true and correct to the best of my owledge. I also grant PDE peission to release my name and complaint details to the institution. SIGNA OF COMPLNANT DA