Complaints and Appeal Lodgement Form

Complaints and Appeal Lodgement Form
Please indicate which of the following applies to you:*

Current studentHost EmployerStaffOther
Please indicate if you are lodging a complaint, appeal or an assessment appeal.:*

ComplaintAppeal (unrelated to assessment)Assessment AppealOther
SECTION 1 - Personal Details
Name*

PrefixFirst NameLast Name
Gender*

MaleFemaleOther
Email Validator*
Contact Number*
Date*

DayMonthYear
Date
Select campus*
SECTION 2 – Course / Unit/ Module Details
Student ID
Code/Title:
SECTION 3 – Complainant Declaration
I have read and understood the AICSE Complaints Policy and I declare that the other party to the complaint may be contacted in an attempt to resolve the issue. I agree that AICSE 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 relates:*

Training MaterialsSupport Services providedTraining FacilitiesCHC Work PlacementPersonal conflict/BehaviourDiscriminationCampusVictimisationTraining – OtherAssessment - OtherPrivacy BreachAttendanceCourse ProgressFinanceSIT work placementIT issuesSystem Access(Moodle/axcelerate)Enrolment/AdmissionCourse Progress-Diploma of Community ServicesOther
Does your complaint/appeal involve another person (e.g. Trainer/Assessor/other student)?*

YesNo
If yes, please provide their name:
Does your complaint/appeal involve witnesses?*

YesNo
If yes, please provide the name/s and contact details of witnesses who are willing to support your claim
Please outline the nature/circumstances of your complaint/appeal:*
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*

DayMonthYear
Date
Complaints and Appeal Lodgement Form | V3 - Revised 7/8/2023
Should be Empty: