Citizen Compliment/Complaint Form

Timer

--:--

* = required field

Some content may be updated based on selection

University Police

MTSU Box 141
Murfreesboro, TN 37132
615-898-2424

Citizen Complaint / Compliment of Employee

Name:

Date of Birth:

Phone Number:

Driver License Number:

Address:

City:

State:

Zip Code:

Name(s) of Employee Involved (if known):

Date:

Time:

Location:

Details: (Please state your complaint, including names, times, locations, witnesses, and any other information that would help

investigating your complaint)

I swear or affirm that the statements I am reporting in this complaint are true and accurate to the best of my knowledge with the understanding providing false information is a crime. TCA: 39-16-502

Middle Tennessee State University does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, religion, creed, national

origin, sex, sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or against any other legally protected class with respect to all
employment, programs, and activites. The following person has been desinated to handle inquiries related to nondiscrimination policies for MTSU: Assistant to the President forInstitutional Equity
and Compliance. For additional information about these policies and the procedures for resolution, please contact Marian V. Wilson, assistant to the president and Title IX Coordinator,
Institutional Equity and Compliance, Middle Tennessee State University, Cope Administration Building 116, 1301 East Main Street, Murfreesboro, TN 37132;
Marian.Wilson@mtsu.edu; or call (615) 898-2185. MTSU's policy of nondiscrimination can be found at http://www.mtsu.edu/titleix/.

Please wait for files to finish uploading

Are you ready to submit your form?