Chemistry Concern Form – Chemistry

This form may be used for any type of concern you would like to address related to your experiences in Chemistry, but it is not a Carleton Community Concern form.

Chemistry Department Concern Form

This form may be used for all types of concerns you would like to address but it is not a Carleton’s community concern form. (If you are looking to submit a Carleton Community concern form go to https://www.carleton.edu/dean-of-students/forms/community-concern/)

Today's date
MM slash DD slash YYYY
What is the nature of your concern?*
Please give a brief description of what prompted you to contact us.
Who in a Chemistry-related activity or setting is causing your concern?
Name(s) of specific person(s), if known, or some identifying information (Ex: Intro student with long, curly red hair, Tuesday PSF, Professor XY)
When and where did the concerning incident happen?
Give a date and approximate time, if possible, or a range of time (ex: multiple instances during Fall Term) and location (classroom, hallway, outdoor space, etc)
Write your email if you want us to follow up with you.

By default, this form is submitted anonymously to Tami Little. However, we can’t work with you personally if you choose to be anonymous. If you would like personal contact, Tami will direct your concern to a person of your choosing (list below); you can expect to be contacted within 2-3 days. In any case, your personal information will not be shared with anyone other than Tami and that person without further permission from you.
Who would you like to follow up with you about this concern? (If anyone)
Name
This field is for validation purposes and should be left unchanged.
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later