Student Request for Review of a Decision or Action

Student Grievance, Complaints and Appeals Form

Confidential
Note: Before filling out this Form please refer to the Student Complaints, Appeals and Grievances Policy and Procedures and/or the Academic Appeals and Review of Grades Policy and Procedures, available on our website.
1. Student Information
Type of request:

Other
Status
Name
Student Number if enrolled
Signature
Date

DayMonthYear
2. Overview of Complaint, Grievance, or Appeal
1. What decision or action does your complaint appeal or grievance relate to? Please describe the decision or action indicate who made the decision or took the action and the approximate date when this happened
2. What action or outcome are you seeking from your complaint/ appeal/ grievance?
3. Do you agree to the Institute discussing your complaint, appeal or grievance?
4. Who do you want us to discuss the matter with? Who can provide relevant information?
5. Is there any person you do not want this discussed with? If so, who?
6. What evidence, documents, further information have you included with this request? Please list your attachments here and attach them to this request - this may include further details relating to points 1, 2 and 3 if there is insufficient space in this form.
File Upload

Cancelof
Office Use Only

(To be completed, copied, and returned to the student confidentially, including copies of any attachments provided by the student)Student: Please regard this as a receipt of your request for a review. Your Contact Officer who will keep you informed of progress, and who you can provide any additional information to is provided below.
Name
Email
example@example.com
Signature
Date

DayMonthYear
Should be Empty:

Student Grievance, Complaints and Appeals Form

1. Student Information

2. Overview of Complaint, Grievance, or Appeal

Office Use Only