Student Concern Form

Do you have a question, concern or comment for the Ombuds? If so, please fill out this form, and we will respond as soon as possible.

NOTE: Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to the University. Instead, contact the specific office or individual by phone or in writing. For more information, please see the University of Florida's "Online/Internet Privacy Statement" at http://privacy.ufl.edu/privacystatement.html.

Personal Information *Required
First Name*:
Last Name*:
UFID*:
College Major*:
Local Address*:
Local City*:
Local State*:
Local Zip*:
Permanent Address*:
Permanent City*:
Permanent State*:
Permanent State & Zip*:
Contact Email*:
Local Phone*:
Other Phone:
Petition Information *Required

Which type of petition have you filed?*

Retroactive drop
Retroactive withdrawal
Refund of fees
Waiver of fees
Other:

Have you filed a University Senate Petition with the Registrar's Office?*

Yes
No

Have you filed any other petitions?*

Yes
No

Have you discussed your concerns with your instructor, dean, or other administrator?*

Yes
No

Please briefly and clearly describe the nature of your concerns.*

There are errors on your form, please fill in the missing information.