Discrimination Report Form
Section 1: Personal Information
Full Name
Email Address
example@example.com
Phone Number
Student ID Number (if applicable)
Program of Study (if applicable)
Please Select
CHC30121 Certificate III in Early Childhood Education and Care
CHC50121 Diploma of Early Childhood Education and Care
BSB50120 Diploma of Business (Digital and Data)
BSB60420 Advanced Diploma of Leadership and Management
BSB80120 Graduate Diploma of Management (Learning)
BSB50820 Diploma of Project Management
BSB60720 Advanced Diploma of Program Management
ICT50220 Diploma of Information Technology (Business Analysis)
ICT60220 Advanced Diploma of Information Technology
BSB40820 Certificate IV in Marketing and Communication
BSB50620 Diploma of Marketing and Communication
BSB60520 Advanced Diploma of Marketing and Communication
General English
Section 2: Incident Details
Type of Discrimination
Racial
Gender
Age
Disability
Sexual Orientation
Religious
Other (Specify)
If Other, Please Specify
Date of Incident
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Month
-
Day
Year
Date
Location of Incident
Description of Incident
Provide a detailed description of the incident, including any relevant context or actions taken.
Persons Involved
Include names and roles of all persons involved, if known.
Witnesses (if any)
Provide names and contact information for any witnesses.
Section 3: Supporting Documentation
Upload Supporting Documents
Browse Files
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Choose a file
Upload any relevant documents or evidence related to the incident (e.g., emails, screenshots, photos).
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Section 4: Desired Outcome
Desired Outcome
Describe what you would like to happen as a result of this report (e.g., investigation, mediation).
Section 5: Agreement to Terms
Agreement to Report Policy
*
I have read and agree to Rosehill College’s Discrimination Report Policy.
Consent to Data Processing
*
I consent to the collection and processing of my personal data as described in Rosehill College’s Privacy Policy.
Confidentiality Agreement
*
I understand that the information provided will be kept confidential and used solely for the purpose of investigating this report.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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