KU Ombuds Intake Form
KU Ombuds Office Intake Form
 
The Ombuds Office provides impartial, independent and confidential support services to all members of KU community. We are focused on ensuring that all students, staff, and faculty are treated fairly and equitably. If you believe you have been treated unfairly, need information, or wish to speak to someone about a concern, please fill out this form and you will be contacted to set up an appointment.
 
The information you report on this form will help prepare us for our meeting with you, and will help us keep track of the type of issues facing students, staff, and faculty at KU. As with other information you share during a visit with the Ombuds, confidentiality will be maintained by our staff.
 
General Information:
First Name:*    Last Name:*   
Email:*    Contact number:*   
School/College:    Non-Academic Unit:   
Department/Program:    Race/Ethnicity:   
Do you supervise one or more people?    Gender Identity:   
Previous contact with the Ombuds Office?    Preferred Personal Pronoun:    
KU Community Membership:*    Age:   
Years at KU:   
 
Request for Assistance:
Referred by:   
Nature of Issue:*   
Reasons for coming to the Ombuds office:* 
 Unfair Treatment
 Need Information
 Raise a Concern
 Discuss Possible Options
 Other  
 
Have you consulted anyone else about this issue?   
If yes, who did you consult?  
How do you prefer we contact you?*   
 
 
 
 
Acknowledgement:

Ombuds Office is a confidential, independent resource authorized to informally address faculty, student and staff concerns from a neutral position, ultimately facilitating the process of conflict resolution. All interactions with the Ombuds are strictly confidential except cases where there is consent by complainant; imminent harm to the complainant, others or University; or a legal concern. The Ombuds does not operate as an advocate for individuals or the University, but as an advocate for fairness of outcomes. The Ombuds is an independent entity and reports directly to the Office of the Provost. The Ombuds works informally to achieve fair and equitable solutions to concerns; we are not a licensed attorney.
 
***PLEASE note that because of the confidential and informal nature of the Office of the Associate Ombudsman, it is not considered an "office of notice" to the University. To give notice to the University, an individual must go to the appropriate office or personnel. ***