Student Grievance Application Form – Southern Cross Institute

Student ID

Given Name(s)

Surname

Telephone Number

Email Address

Current Address

Course

Major

This form should be used if you wish to lodge a formal grievance at the Southern Cross Institute (SCI). Your application will be assessed in accordance with the Student Grievance Management Policy and Procedure.

If you do not wish to formally lodge a complaint/appeal, you are encouraged to resolve grievances informally by speaking with your lecturer/tutor or Student Support Manager.

A grievance of an academic or non-academic nature may be lodged by submitting this form. Academic grievances may include:

Matters of academic advancement
Assessments including examinations;
Course curriculum, and/or
awards in a course of study.

[email protected]

Description of Grievance

Please provide a brief description of your grievance/complaint, how it arose, and what steps you have taken to resolve your grievance, including dates. Add extra information as necessary.

Supporting Evidence

Please outline the evidence that you have in support of your grievance (you should attach additional documentation as necessary).

Form of Resolution Sought

Please briefly describe the outcome you would like to resolve your grievance.

Consent(Required)

I declare that the information provided by me on this form is true. I have read and understood the information about the grievance management procedure as outlined in the Student Grievance Management Policy and Procedure. I agree and give my consent to SCI to release my personal information for the purpose of resolving this complaint/appeal.

If it is for office use

Official Use Only

Received By Name

Reviewed by Name