This form is to be completed under the Formal Stage of the

							Student Complaints Policy and Procedures                             APPENDIX 2 –
                                                                     Complaints Form

  Notes for completion
  1. This form is to be completed to request consideration of your complaint at the Mediation
     Stage of Bournemouth University’s Student Complaints Procedure.
  2. The deadline for submitting a complaint for mediation is 10 working days after the date of
     the final response form the Local Stage. Complaints received after the deadline will not
     normally be considered.
  3. Advice on completion of the form can be obtained from Student’s Union Student Advice
     Centre (email studentadvice@bournemouth.ac.uk or phone + (0) 1202 965779) or askBU
     (email askBUstudents@bournemouth.ac.uk or phone + (0) 1202 969696).
  4. The University reserves the right to reject any complaint at the Mediation Stage if it clearly
     does not fall within the scope of the Student Complaints Procedure.

  5. Forms can be submitted by e-mail to complaints@bournemouth.ac.uk or by post to:
      Appeals, Complaints and Conduct Officer, Room PG04 Poole House, Talbot Campus, Fern
      Barrow, Poole, Dorset BH12 5BB
  6. Forms will be acknowledged (to the complainants postal or email address indicated on the
     form) within 5 working days of receipt.
  7. If this document is not in an accessible format to you, please email
     complaints@bournemouth.ac.uk or contact askBU and we will endeavour to supply the
     information in a more suitable format.




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Student Complaints Policy and Procedures                            APPENDIX 2 –
                                                                    Complaints Form
  COMPLETE IN BLOCK CAPITALS OR TYPE.

  1.      Personal Details

  Full Name: ____________________________________ Student ID No: _______________

  Programme and Year of Study: ________________________________________________
                                      st
  (E.g. BA (Hons) Business Studies 1 year)

  (NB in the case of a Group Complaint, please attach a list of complainants on a separate sheet
  of paper)

  Address for correspondence in connection with the Complaint

   _________________________________________________________________________

   _________________________________________________________________________

   _________________________________________________________________________

  Postcode: _______________________

  Telephone number: _______________________

  2.      Complaint Details

  2.1   Outline of Complaint, including dates of actions (please use additional sheets if
        necessary):




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Student Complaints Policy and Procedures                              APPENDIX 2 –
                                                                      Complaints Form
  2.2     Please explain here what steps you have taken, together with dates, to resolve your
          complaint locally (include any discussions you may have had with programme leaders,
          Student Advice Centre staff etc). Please attach copy of local stage response.




  2.3   Please explain why you are unsatisfied with the response you have received from the
        School or Support Service:




  As part of the investigation of your complaint, any member of staff mentioned will be
  made aware of the complaint, as will the Dean of the School or Head of Professional
  Service involved.

  2.4   Please indicate, without prejudice, what outcome or further action you are requesting:




  2.5   If you have written a formal letter of complaint to anyone else in the University please
        indicate names and / or let us know whether you intend to copy this to anyone else.


  3.       Declaration
  I declare that the information given in this form is to the best of my knowledge true, and that I
  would be willing to answer further questions relating to it if necessary.


  Signed: ___________________________________________Date:______________




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