Complaint Form

Student Information:
Today's Date
Student's Name
Name of individual filing complaint if different from student(*)
Address
Telephone Number	(		)
Best time to call during regular business hours	Between ________ am/pm and ________ am/pm.
I am filing a complaint against the following school:
Name of School
Address
Telephone Number	(		)
Exact Dates of Attendance:
Date you entered classes: __________________ Last day of attendance: ___________________
Did you complete the program into which you enrolled? [__ ] yes [__ ] no
*Except in cases where an individual was under 18 years of age at the time of enrollment, the agency cannot act on complaints filed by another person and cannot discuss a complaint with such other individuals.  In instances involving a minor, a parent/legal guardian must act for the student.
Financial Information:
Please indicate which of the following apply. Show more than one source if tuition/fees are being paid from various sources.
[__ ] The school has received payment on my account to date of $____________________. The source(s) of those payments on my account are: [ __] Funds supplied by myself/family: no outside assistance. [ __] Scholarship award: (Source?) _____________________________________ ____________________________________________________________________ [ __] Funds obtained from Federal financial aid grants/loans. [ __] Funds provided by a public agency (DVR, VA, ES, DSHS, other). Please indicate which: ___________________________________________________________ [ __] Other: ___________________________________________________________

 

COMPLAINT CONCERNS:
A student may file a complaint if the school has committed an unfair business practice. The following is a list of unfair business practices for which a student can file a complaint. (Check one or more of the following, if applicable, and explain each, in detail, on a separate paper.)

Unfair Business Practices

_____(1)School failed to comply with the terms of a student enrollment contract or agreement;

_____(2)School represented falsely, directly or by implication, that an educational program is approved by a particular industry or that successful completion of the program qualifies a student for admission to a labor union or similar organization or for the receipt of a state license in any business, occupation, or profession;

_____(3) School represented falsely, directly or by implication, that a student who successfully completes a course or program of instruction may transfer credit for the course or program to any institution of higher education;

_____(4) School represented falsely, directly or by implication, in advertising or in any other manner, the school's size, location, facilities, equipment, faculty qualifications, or accreditation;

____(5) School represented that the school is approved, recommended, or endorsed by the state of Washington or by the agency, except the fact that the school is licensed  to operate in the State of Washington;

____(6) School provided testimonials, endorsements, or other information which misled or deceived student regarding current practices of the school, current conditions for employment opportunities, or probable earnings in the occupation for which the education was designed;

____(7) School designated or referred to sales representatives as "counselors," "advisors," or similar terms which have the tendency to mislead or deceive prospective students  regarding the authority or qualifications of the sales representatives;

____(8) School made or caused to be made any statement or representation in connection with the offering of education if the school or agent knows or reasonably should have known the statement or representation to be false, substantially inaccurate, or misleading;

____(9) School engaged in methods of advertising, sales, collection, credit, or other business practices which are false, deceptive, misleading, or unfair, as determined by the agency.

YOUR COMPLAINT:

Have you tried to resolve your complaint with the school?

Yes __________  No __________On what date?  ________________

Whom did you contact?  Name______________________________________________

Title ___________________________________________

What was the outcome after discussions with school officials?

Please describe, in order, the events, dates, and names relating to your complaint.  (Use additional paper if necessary).

 

 

What you want to happen to satisfy your complaint? 

 

NOTE:  IF CLAIMING A REIMBURSEMENT, the agency must obtain evidence that you enrolled in/paid money to the subject school.  Please attach copies of your enrollment agreement, receipts for payment(s) made, canceled check(s), money order receipt(s), etc.  This could include tuition charges, registration fees, transportation costs to/from school, purchase cost of required insurance, books, supplies, equipment, uniforms and protective clothing or devices, lab and other related user fees or rental charges

IMPORTANT PRIVACY INFORMATION: As a state agency, the Workforce Training and Education Coordinating Board is subject to state public disclosure laws. While financial information such as check accounts, social security numbers and credit card information will not be disclosed, your name, address and phone number on this form might get disclosed in the event of a public records request. State law prohibits the use of this information for commercial purposes.

Document your discussions and correspondence and collect all relevant information such as copies of school catalogs, advertisements, contract and brochures. Forward copies of supportive documents to us with your complaint.

I certify under penalty of perjury under the laws of the state of washington that the foregoing information and/or attached exhibits are true and correct.

 

Date  ______________    Place__________________________________________ (City where signed)

__________________________________________________________
(Print or Type Name)                       (Signature)