This form is to be completed in support of Stage 2 of the University’s Student Complaints Procedure.
Please read the Student Complaints Procedure before completing this form.
In investigating your complaint, LSBU will take every care to safeguard your privacy and condentiality.
However, any member of sta mentioned in the complaint will be made aware of the issues raised and will
have an opportunity to comment on them. In addition, it may be necessary to share your complaint with other
individuals within the University if we require further information.
Please note that it is expected that you rst attempt to resolve the complaint informally (this should be within
three months of the event(s) about which you are complaining). If you remain dissatised you should submit a
formal Stage 2 complaint within one month of the outcome to a Stage 1 informal complaint.
1. Personal Detail
Name
Student Number
School
Programme of study
Contact address
Contact telephone number
Contact email address
Dates of the event(s) about which you are complaining
Student Complaint Form
2. Stage 2: formal complaint
Please set out the reason(s) why the complaint is being made and specify:
a. who or what is being complained about;
b. the events that took place in chronological order; and
c. the consequences that you believe you have suered as a result
Add additional sheets as necessary
N.B. Should you wish to provide additional supporting documents, please attach these to this form.
3. Stage 1: informal complaint details
Please summarise your attempts to resolve your complaint informally at Stage 1.
Have you had a conciliation meeting? NoYes
To whom was the initial complaint made:
Date of meeting:
Why do you remain dissatised with the response to your Stage 1 complaint?
4. Desired outcome or remedy
Please indicate the outcome you seek in making this complaint.
N.B. LSBU will make every eort to resolve all complaints to the students satisfaction but please note
that it may not be possible in all cases.
5. Attached documents
Please list any documents supplied in the space below and attach them to this form or include as
additional attachments via email.
a.
d.
c.
b.
6. Data protection
I hereby consent for any sensitive/condential personal data, such as counselling records, held by the
University to be made available to the Student Complaints Ocer for use as evidence or supporting
documentation as appropriate. I understand that as part of the investigation into my complaint, the
Student Complaints Ocer may be required to share this information with other LSBU sta on a
need-to-know basis.
I declare that to the best of my knowledge all of the information I have supplied is true, accurate and
complete.
I give my consent for information in this Student Complaint form and attached documents, and
personal data held elsewhere within the University, to be shared with relevant members of
University sta on a need-to-know basis for the purpose of investigating my complaint.
Signature
Date
N.B.
Should you require advice or assistance in completing this form, or in relation to any other
aspect of LSBU’s Student Complaints Procedure, please contact any of the following: LSBU’s Student
Life Centre, LSBU’s Students’ Union or LSBU’s Disability and Dyslexia Support Services.
Please submit the completed form to the Student Complaints Ocer, London South Bank University,
Technopark, 90 London Road, SE1 6LN.
Alternatively, you can email the form to mitchen5@lsbu.ac.uk.
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