Prior to initiating this process students are strongly encouraged to speak with faculty involved in their concern/problem. Students may also choose to speak with the Program Coordinator or the individual who oversees the degree program. Today's Date Student Information Student Name First Middle Last Student PSU Email Summary of Student Concern/Problem: Faculty member(s) involved: Related course(s): Please be specific in describing your concern/problem: Upload any supporting documentation related to your concern, such as course syllabus, copies of relevant emails, etc. Upload Upload requirementsUnlimited number of files can be uploaded to this field.5 MB limit.Allowed types: txt, doc, docx, xls, xlsx, pdf, ppt, pptx, pps, ppsx, odt, ods, odp. Upload any supporting image documentation related to your concern Upload Upload requirementsUnlimited number of files can be uploaded to this field.5 MB limit.Allowed types: gif, jpg, png. Actions taken prior to initiating the Student Faculty Mediation Process Did you speak to the faculty member involved or the Program Coordinator who represents the discipline: Yes No Who did you speak with? What was the outcome? Please speak to the faculty member involved or the Program Coordinator who represents the discipline prior to moving forward with this process. CAPTCHA × Information message Thank you for completing this form. It is the goal of the committee to review the SFMP form within 72 hours of receiving it. Students will receive an email to schedule a meeting. Submit