Student Feedback Resolution Acknowledgment Form
Please complete this form to formally acknowledge the review and resolution of student feedback.
Student Name
*
First Name
Last Name
Student Email
*
example@example.com
Date Feedback Received
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Feedback Category
*
Please Select
Academic
Facilities
Student Services
Technology
Other
Feedback Description
*
Resolution Provided
*
Date of Resolution
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Staff Name (Reviewed/Resolved By)
*
First Name
Last Name
Acknowledgment of Review and Resolution
*
I acknowledge that the feedback has been reviewed and resolved.
Signature of Staff Member
*
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: