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Complaint form

The personal information on this form is being collected under the principles of the Information Privacy Act 2014 (ACT) to enable 涩里番to process your complaint.

There is no cost to have your complaint addressed.

* required fields

Complainant Information

Name *

Date *

Email address *

Contact number *

涩里番number

(if you have one)

Relationship to 涩里番*

Name of Qualification you are applying for, currently studying or have studied that relates to this complaint

(if applicable)

Name of the section of 涩里番your complaint concerns

(if applicable)

Information about your complaint

If your complaint is about a particular person or persons, please identify the person, their position and how they relate to you.

Name of the person/s involved

Position/s

(if known)

Please state your allegation (s), the alleged 'wrong doing' (who was involved, what happened, where did this happen and when did this happen).

What is the nature of your complaint *

If you have additional information, evidence etc, please upload here. If you don鈥檛 have enough space above to outline your complaint, please upload in a word document with further information here:

Additional information/evidence

(if required and it needs to be less than 10MB in file size)

Is there any potential person's who might be able to support your complaint as a witness? If so, please add their details below, ensuring 涩里番has a way to contact them.

Witness 1 name

Witness 1 email and/or mobile number

Witness 1's relationship to you

Witness 2 name

Witness 2 email and/or mobile number

Witness 2's relationship to you

Witness 3 name

Witness 3 email and/or mobile number

Witness 3's relationship to you

Have you told anyone at 涩里番(for example, your teacher, Head of Department, College Director, Student Services, CITSA) about your complaint? *

If yes, who have you told and what action/s have they taken?

Is there any other information you would like to include?

What is the resolution or outcome you are seeking regarding your complaint? *

I declare that the information I have provided to the best of my knowledge is true and correct *

*I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

Name *

Date *