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Complaints / Appeals Form
ALACC Health College, Australia requires as much detail as possible about your complaint so that we can address it accurately and thoroughly.
Full Name *
Birth Date *

Day Month Year
Email *
example@example.com
Phone Number *
Current Course undertaking
Complaint is from

Student Staff
Detailed explanation of complaint / appeal (You may wish to attach further documentation)
Attach any relevant documents here ( you can select multiple documents when attaching)

Select File

Cancel of
Please give details of the outcome you are seeking.
Please check the complaints and appeals procedure, so that you can understand the procedure involved with your complaint and/or appeal (If complaint received in person) I agree that all the information provided within is true and correct.
Signature *

Clear
Date *

- Day - Month Year
at
: Hour Minutes AM/PM Option Date Picker Icon
PRIVACY NOTICE The information provided on this form will be used by ALACC Health College, Australia to follow up your complaint. The information may be provided to ALACC Health College, Australia or staff who is in a position to remedy your complaint; or to the police for law enforcement purposes. The provision of this information is voluntary. It will be stored securely. You may correct any personal information provided at any time by contacting the person to whom you submit this form.
Office Use Only
Complaint received by

Phone Fax In person E-mail
Attach copy of e-mail here
(If complaint received via telephone) I agree I have recorded an accurate description of the complaint / appeal

true
Signature of Staff *

Clear
Staff Name
Click to edit

- Day - Month Year
at
: Hour Minutes AM/PM Option Date Picker Icon
Complaint Type

Complaint Appeal
Action Taken
Date and briefly state how the Student/or Staff was advised of the outcome
CEO/Director of Studies Signature

Clear
COMPLAINT OUTCOME
Australasian Lawrence Aged Care College has investigated your issue and has based the outcome on all relevant information gathered from various sources. We strive to be fair, equal and unbiased when dealing with any issue. Below we have explained the outcome and reasons/action taken in relation to your complaint / grievance / appeal.
Full Name
Date

- Day - Month Year
Date Date Picker Icon
Position

Student Staff
Course undertaking
Trainer
Date of your complaint

- Day - Month Year
Date Date Picker Icon
Brief details of your complaint / appeal
Outcome details including reasons
Should be Empty:

Complaints / Appeals Form