Student Feedback/ Concern Report

Date 今天日期

First Name 名字

Last Name 姓名

Email 电邮

Phone/Mobile 电话/行动

Is this for your student or your student's parents? 这是有关您的学生还是您的学生家长？

My Student 我的学生

My Student's Parents 我的学生家长

How many people are involved in the case (excluding yourself)? 有多少位人员在您想反应的事情里（不包括您自己）？

Student First Name

Student Last Name

Parent First Name (If you know)

Parent Last Name (If you know)

First Name

Last Name

First Name

Last Name

First Name

Last Name

What's your main concern? (Required) 您想反馈或告知办公室什么事情或情况？（麻烦填写）

Did you try to communicate any of your concerns with your student or student's parents first? 您是否已经尝试先与学生或学生家长沟通任何您的疑虑或想法？

Yes, I did 是的，我已经尝试了

No, I did not 我还没有

I do not feel comfortable 我觉得自行沟通有些不妥或不舒服

Any things you would like to share with our office? 任何您还想与我们的办公室分享的资讯？

Would you like us to keep your concerns or issues private without notifying your student/parents? 您希望我们将您的疑虑或问题保密而不通知您的学生/家长吗？

Yes, please keep it private without sharing, I just want to inform office 是的，请保密，不要分享，我只是想通知办公室

No, but please keep my name private, I still need office to communicate with the student/parents 不是的，我需要办公室与学生/家长沟通，但请把我的名字保密，

No, I need office to communicate with the student/parents and I do not mind that office share my name and brings my concerns directly to the student/parents 不需要，我需要办公室与学生/家长沟通，并且我也不介意办公室分享我的名字和麻烦把我的忧虑和担心直接转给学生/家长

Others 其他

"Others" in more detail 上方“其他” 更详细解释

What would you like to do? (You can pick more than one) 您希望接下来如何处理？（您可以选择多项选择）

Only express my concerns 只是希望表达我的想法

Would like the office be aware of 只是希望办公室知道这些事情

Continue with the student, but need office to communicate with the student/parents 继续保留目前的学生/家长，但是希望办公室可以出面和学生/家长反应和沟通

Others 其他

Any other things you would like to share with us? 您还有其他任何想法想和我们分享吗？

We appreciate you spend the time to express your concerns and let office know how you truly feel!

我们忠心感谢您花您宝贵的时间表达您的想法或担忧，并和我们办公室分享您真实的感受，再一次感谢您，您的反馈，我们会非常重视！