Formal Complaint Form
Please complete all sections – the form will expand where completed electronically
Student Name
Student
Number
Contacting you. We will use your student email address
unless otherwise specified.
If this is a complaint made by a group of students, give
the name and contact details of one agreed point of contact.
Year and Course of
study and campus
Complaint relates to:
 Delivery of a course of study
 Delivery of a University service
 Action or lack of action on the part of the University
 Unfair treatment during an assessment process
Conduct of a University staff member  Conduct of a University student
 Other, please state:
If your complaint is about an assessment outcome eg: you believe there has been an
administrative error, regulatory or procedural irregularity that has affected your outcome, an Academic
Appeal may be more relevant. Please contact the Students’ Union for guidance and see
http://my.cumbria.ac.uk/StudentLife/Support/YourStudies/AssessmentandExams/Appeals.aspx
Have you also submitted Extenuating Circumstances or
Yes / No
an Academic Appeal? If yes, the outcome of this complaint may
be referred to the EC Panel or Secretary of the Appeals Panel.
Informal Complaints: If you have raised the concerns
informally in the first instance, tell us who with and when:
Do you have a disability or specific
learning difficulty you would like us to be
aware of when considering your complaint?
Yes / No
Yes / No If yes please give details of adjustments that
will assist you during the complaint procedure.
Students’ Union. We strongly recommend you contact the Students’ Union for independent,
confidential and free advice and guidance when making your complaint. Details online via:
http://www.ucsu.me/support
Would you like all correspondence related to your complaint to also be sent to
Yes
No
your Students’ Union caseworker via [email protected]?
please
thanks
Details about your complaint: NB: You should include all information with this form. We may not be
able to accept additional information as the procedure progresses. Use the Checklist, available online,
to guide you. List any documents included to support your complaint, if applicable.
What remedy/outcome would you like to be considered? (Requested remedy will be considered
where all or part of the complaint is upheld but is not guaranteed).
I have read and understood the scope and timeframe (Policy S5&10) and information about making a
complaint (Procedure S2&3 onwards) in the Student Complaints Procedure. I understand that I may
seek information, advice and guidance from the Students’ Union at any time during this procedure.
Signed (Student)
Date:
Send your completed form to [email protected]
This form is subject to amendment from time-to-time. This form, the full policy and procedure and Checklist can be
downloaded from http://my.cumbria.ac.uk/studentcomplaints. If you require an alternative format, please contact
[email protected].
Formal Complaints form 201617