Office of the Ombuds

Intake Form

Thank you for contacting the Office of the Ombuds. The role of the Office of the Ombuds at EMU is to help students resolve concerns, problems, or conflicts with regards to University policies, procedures, and decisions. The Office of the Ombuds provides for an informal and neutral place for students to come to express their concerns. Students work with the Office of the Ombuds to identify steps that may be taken to achieve a timely and fair resolution to a problem.

In order to best assist you with resolving your concerns the Office of the Ombuds asks that you please fill out the intake form below. This form allows the office to have the necessary information to look into your concern and move forward in working with you in determining the options available to you. Once you have completed and submitted the form the office will be able to assist you with your concern.

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Contact Information


Please provide your full name.


Please list your EMU ID Number.


Please provide your phone number so that we can contact you if we have follow up questions about this intake form.


Please provide your email address so that we can contact you if we have follow up questions about this intake form.


Please provide your mailing address so that we can contact you if we have follow up questions about this intake form.

Descriptive Information


Please select the concern(s) that you are contacting the Office of the Ombuds in regards to. It is important to select all areas that apply to your concern.

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Please list the names of the individuals involved related to this concern.


Please provide as much information as possible about your concern.


Please describe the steps you have taken to resolve this concern, providing the names and/or offices you have communicated with.


Please describe the solution you are seeking..

Demographical Information


Who referred you to the Office of the Ombuds?

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Select the following that best describes your relationship to EMU.


Select what best describes your current student status.


Please list your current major/minor.


We ask that you please provide the following information. Even though this information might be irrelevant to the concern for which you are seeking assistance, it is important for our record keeping. We would appreciate your sharing the following information, be we respect your right to not provide it.


We ask that you please provide the following information. Even though this information might be irrelevant to the concern for which you are seeking assistance, it is important for our record keeping. We would appreciate your sharing the following information, be we respect your right to not provide it.

I have attempted to resolve this matter but could not find a neutral or "reasonable" solution to the problem. Therefore, I am authorizing the Office of the Ombuds to discuss my concern with anyone involved to help find an informal resolution to this matter. The Office of the Ombuds reserves the right to discuss cases with university officials with a legitimate educational interest, maintaining limited confidentiality within the scope of conflict resolution and the university personnel involved. The Office of the Ombuds is not an advocacy office. I also understand that communications to the Office of the Ombuds does not constitute notices to the University nor to its staff. I understand that, due to the limitations of technology, confidentiality cannot be assured when using e-mail. With my signature, I give full authorization to the Office of the Ombuds to negotiate a resolution on my behalf.


Per FERPA regulations, I hereby authorize the Office of the Ombuds to discuss this matter with the following family, friends, or individuals (specify names, including contact information):


Please place your electronic signature (full name) in the following box to verify the above authorization statements.