Complaints and Appeals Form

Complaints and Appeals Form
Date the cause of complaint occurred:

MonthDayYear
Date
Date

MonthDayYear
Date
If yes, please list the date complaint was lodged:

MonthDayYear
Date
Date the cause of complaint occurred:

MonthDayYear
Date
Stage 1 (Informal Resolution)
Please ensure that you have tried to resolve the complaints by first approaching the relevant members of the staff. (Students who wish to lodge complaint/appeal are to fill in this form and meet the Student Services Officer/Student Welfare Officer)
Personal Details:
Full Name:*
Position of Complainant/Appellant*
Phone No:*
Email:*
example@example.com
Address:*
If the complainant is student, please provide the following details
Student ID:
Course Name:
Complaints/Appeal details
Complaint Details

Date the cause of complaint occurred: Date
General OperationsAssessmentESOS related complaintOther
Have you complained about the issue before?
Yes No
If yes, please list the date, the complaint was lodged: Date
Appeal Details

Date the cause of complaint occurred: Date
Assessment outcomeAny outcome of any application for requestAny disciplinary action taken against youOther (Please specify below)
Complaint/Appeal Summary: Please give detailed explanation of complaint/appeal and attach any supporting evidence (add additional sheets where required)
File Upload

Upload any evidence you wish to submit
Cancelof
All the information provided in this form is correct and accurate to the best of my knowledge.I am happy to attend any meeting with relevant persons required to resolve the issue.
Signature*

Clear
Date:*

DayMonthYear
Date
Should be Empty:

Complaints and Appeals Form

Stage 1 (Informal Resolution)

Personal Details:

Complaints/Appeal details