ࡱ> ] bjbj !b!b 0 2228jT2"("!!!!!!!$#&!tt"!! R! ! p= n!!0" 5'5' 5'  !! "5' B : For Staff Use Only Student Complaint Procedure Stage 1 - Raising a Concern/Complaint Form Please refer to the Student Complaint Procedure and Refunds & Compensation Policy 2018-19 which is available on the  HYPERLINK "http://www.bolton.ac.uk/studentinformation-policyzone/Home.aspx" Student Information Policy Zone STUDENT DETAILSFull Name of StudentStudent Status Current Student/Past Student/Other (please specify)Student NumberContact Address (including postcode) Telephone NoE-mailComplaint considered by (Name, Position, School/Service/Unit/Department)EARLY RESOLUTION (raising a concern) Students are encouraged to raise a concern with the person directly related, on a day to day basis, with the issue with which they are concerned in order address the issue quickly if possible. This form is intended to help you to gather the information from the student in order that you can, if possible, resolve the issue. If this is not possible the details should be passed to the Head of School/Director of Professional Services should the student decide that they wish to make a Formal Complaint ie Stage 2. CONCERN/COMPLAINT DETAILSWhat happened? When did it happen? Who was involved?How was the student affected?What in particular is the student expressing a concern about or wishes to complain about and what outcome is s/he hoping for? Please make the student aware that the University can only consider outcomes which are reasonable, and which are allowed by the Universitys Regulations, Policies and Procedures. Please also make the student aware that the University will not be able to tell them about some actions if they would breach an individuals rights to data protection and anonymity (such as disciplinary action against a fellow student or member of staff). Element of concern/complaintWhat outcome is the student hoping for?EVIDENCE/DOCUMENTS If possible the student should provide evidence to support their complaint and describe how the evidence supports what they are saying. List of evidence/documents provided: Please label the evidence and describe what it is below. For example, Evidence A is an email sent to the student by the University on 22nd February 2017. Evidence Item A: Evidence Item B: Etc. Would the student consider mediation style intervention to resolve their complaint? (for example parties meeting with impartial ¼ϲʿֱ staff to attempt to determine an acceptable resolution)Yes/No Student Agreement I agree that the information gathered in this form accurately reflects our conversation. I agree that information about my concern/complaint may be gathered from within the University by members of staff in the University. I agree that my name and other necessary information about the complaint may be disclosed in order to properly investigate it. I also understand and accept that the outcome of complaints must be recorded for the purposes of monitoring and analysing complaints generally, and for reporting to Senate and sub committees for monitoring and evaluation in terms of quality assurance as the University is required to undertake for statutory purposes. Such reporting will not include any of my personal details. Signature DateName:  Your written response to the student should be copied to your Head of School/Division or Head/Director of Professional Service and  HYPERLINK "mailto:SEO@bolton.ac.uk" SEO@bolton.ac.uk along with this form for monitoring purposes.     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