Housing Complaint Form - Housing-Related Issues Only

First Name*

Last Name*

Email Address*

Telephone Number*Format: (xxx) xxx-xxxx

Date of incident or situation*

Location of incident

Names of individual(s) accused and/or involved*

Description of incidentPlease write a description of the incident, in chronological order. Provide details concerning your observations, actions of individuals and accurate statements made by all parties that you recall. Include names of witnesses.

Electronic Signature*Please enter your A# as confirmation. I affirm that all of the information provided on this form is accurate and that I am the authorized owner of the indicated student ID (A#).

Contact Us
Office:	Housing/Residence Life & Dining Services
Location:	Miller Hall, Room 121
Phone:	(931) 221-7444
Fax:	(931) 221-7165
Email:	housing@apsu.edu

Office:

Housing/Residence Life & Dining Services

Location:

Miller Hall, Room 121

Phone:

(931) 221-7444

Fax:

(931) 221-7165

Email:

housing@apsu.edu