FORM: STD 09.017 Student Complaint Form Version No. 1

STUDENT COMPLAINT FORM
Please submit directly to Reception or Administration Department. It may take up to 10 working days to review the complaint from the date of submission
STUDENT DETAILS (Optional):
Name

First NameFamily Name
Student ID
Contact Number

Area CodePhone Number
Email Address*
example@example.com
Address
Course*
COMPLAINT DESCRIPTION
I request the college to address the following issue (please select)*

AcademicFinancialPersonalProceduralOther:
Location of issue (if appropriate)
Date*

MonthDayYear
Date
Time*
Briefly describe the issue*
Details of the incident can be uploaded here (e.g. Picture/ Word File/ PDF etc.)

Cancelof
STUDENT DECLARATION:
I declare that all the information I have given above is correct and complete.
Student Signature*

Clear
Date*

DayMonthYear
Date
OFFICE USE ONLY
Received By
Signature

Clear
Date

MonthDayYear
Date
Issue discussed with (staff name)
Date

DayMonthYear
Date
Action taken
Resolved

YesNo
Refer to
Principal Review
Date

DayMonthYear
Date
Record Update

YesNoN/A
Date

DayMonthYear
Date
FORM: STD 09.017 Student Complaint Form LAST UPDATED: June 2018, Version No.1
Should be Empty:

STUDENT COMPLAINT FORM