Cayuga County Community College

Consumer Complaint Form

 

1. Describe specifically your complaint, including whenever possible, dates, names, offices or departments involved in your complaint.

 

 

 

2. Describe any efforts you have made to attempt to resolve the issue or concerns that are included in your complaint. What was the outcome of this effort?

 

 

 

3. What, if any, resolution or outcome are you seeking as a result of this complaint?

 

 

 

_____________________________________________________________
Name

_____________________________________________________________
Address

_____________________________________________________________
Signature

______________________________
Phone Number

______________________________
Date

Office Use Only:


Date of Receipt: _________________________

Received by: _________________________________________________