ACFE Complaints and Appeal Lodgement Form

Complaints and Appeal Lodgement Form
SECTION 1 - Personal Details
Name *

Prefix First Name Last Name
Gender *

Male Female I'd rather not say
Student ID *
Group Number
Phone Number *
Country Code & Phone Number
Email Validator *
SECTION 2 – Course / Unit/ Module Details
Code/Title: *
Date *

Day Month Year
Date
SECTION 3 – Complainant/Appellant Declaration
I have read and understood the Australian Centre of Further Education-ACFE Complaint and Appeal Policy and I declare that the 'other party' to the complaint may be contacted in an attempt to resolve the issue. I agree that ACFE may conduct independent evaluation checks and that I may be requested to submit further information upon request or attend a meeting to discuss this matter further.
SECTION 4 – Complaint Details
Please tick the following areas to which your complaint/appeal relates: *

Training Materials Assessment Materials Services provided Training Facilities Assessment Facilities Personal conflict/Behaviour Training Content Assessment Environment Discrimination Training Environment Assessment Location Victimisation Training – Other Assessment - other (submission,plagiarism, content etc) Privacy Breach
If your complain/appeal is related to unit or assessment , provide the details below:
Unit Title
Assessment Task
Does your complaint/appeal involve another person (e.g. Trainer/Assessor/other student)? *

Yes No
If yes, please provide the name/s and contact details of witnesses who are willing to support your claim
Name

Prefix First Name Middle Name Last Name
Phone Number
Email Address
Does your complaint/appeal involve witnesses? *

Yes No
Please outline the nature/circumstances of your complaint/appeal: *
Type a question
What actions have you taken, in an attempt to resolve this matter:
What action/resolution would you like to see occur/implemented: *
Signature *

Clear
Date *

Day Month Year
Date
Complaints and Appeal Lodgement Form | V1 - Revised December

2020

ABN: 37 135 002 167
Should be Empty: