Complaints and Appeals Form
A. STUDENT DETAILS
Name
*
Email address
*
example@example.com
Address
*
Phone
*
Format: (000) 000-0000.
B. COMPLAINT OR APPEAL DETAILS
Date of Occurrence
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for this Submission:(Please describe your complaint or appeal, including as much information as possible relevant dates and persons involved. Attach any supporting evidence and reference them in your description.)
*
What outcome are you seeking or expect of this complaint or appeal?
*
File Upload: Attach any supporting evidence
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of
C. DECLARATION
Include any other comments.
Can we improve our system to avoid these situations in the future?
I declare that the information provided by me to the best of my knowledge is accurate and truthful and can be used to investigate the complaint or appeal.
Signature
*
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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