Atlanta Metropolitan State College

Academics

Student Communication Form

Please provide the following information: * Indicates Required Field

Name:

* First

* Middle

* Last

Division you would like to send the communication: Student Phone:

(###)

###

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* Email: Date:

Time In: (Please indicate AM/PM) Status at AMSC: (Student, Faculty, Staff, Parent, etc) Your Privacy: I wish to remain anonymousI do not wish to remain anonymous Describe the nature of your complaint or concern giving as much details as possible. Please attach additional information or any supporting documentation: List and/or discuss remedies or resolution sought:

YOUR PRIVACY: AMSC maintains a high level of confidentiality. We do not share information with any other organization and will treat your personal information with care.