Complaints and Appeals Form

Complaints and Appeals Form
Date the cause of complaint occurred:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If yes, please list the date complaint was lodged:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date the cause of complaint occurred:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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
Reason for the complaint:

Other
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
Type a question

Other (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
Declaration
Signature
Date:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Complaints and Appeals Form

Stage 1 (Informal Resolution)

Personal Details:

Complaints/Appeal details