STUDENT COMPLAINTS FORM

This form is intended for use with the Student Complaints Procedure. If you intend to make a formal complaint about the delivery or quality of services received, or the delivery of teaching/supervisory provision or any other matters relating to a programme of study, you must use this form to put forward your case. If you need help in completing this form or require advice you should contact the Student Advice and Counselling Service or the Students’ Representative Council.

This form should not be used for academic appeals.

Please keep a copy of this form for your records, plus any material you submit.

PERSONAL DETAILS

Student ID Number
Programme of Study
Title
Forename(s)
Family Name
Current Contact Address
Postcode
Email
Telephone

STAGE 1 COMPLAINT DETAILS

Please review the list below to ensure you satisfy the criteria to proceed to a Stage 2 or 3 complaint:

I completed Stage 1 (Informal Resolution) of the Procedure on the following date:
The member of staff I spoke to was:
Have you attached written confirmation of this from the member of staff named above (this may be an email)? / -select-YesNo
If you have answered ‘No’ to the above question please confirm when this confirmation will be available.

NATURE OF THE COMPLAINT

Please tick the relevant box below and set out the main points of your complaint. Please see the Student Complaints Procedure for definitions of each.

This is a Stage 2 complaint / (double-click in the box)
This is a Stage 3 complaint / (double-click in the box)
I have attached a clear and concise summary of my complaint / (double-click in the box)
I remain dissatisfied because (please give reasons):

PLEASE LIST ANY DOCUMENTARY EVIDENCE ATTACHED AND MAKE SURE YOU KEEP COPIES:

(e.g. any correspondence, list of dates when events occurred, or other documentation related to your complaint)

DESIRED OUTCOME

Please describe the action you would like to see taken in order to resolve the complaint to your satisfaction.

OTHER INFORMATION

If applicable, please give the name of the Student Adviser or student representative who is helping you in making this complaint:

DECLARATION

I confirm that the above information is accurate. I confirm that details of this complaint can be shared with relevant staff and my adviser or representative (if applicable).

Signature:Date:

When you have completed this form, please submit it to the Head of Registry or via email to .

FOR OFFICE USE ONLY:

Acknowledgment sent
Complaint forwarded
Response received
Reply sent to student
What action (if any) is now needed?
Completion of Procedures letter issued on

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