Name of the higher education provider Check the National Register for higher education providers regulated by TEQSA. What is your relationship to the higher education provider? Domestic student International student Former student Staff member Former staff member Parent / Guardian of student Member of the public Peak body / Advocacy Group Professional association Other higher education provide Agent Other Other Your contact details Providing your name and contact details is optional. You may choose to remain anonymous. Please note that we determine how to proceed with concerns based on the quality of the information we have available. If you remain anonymous, we cannot contact you if we need more information. First name Last name Email Preferred phone number Details of your concern We refer to complaints or allegations of non-compliance we receive about providers as concerns. TEQSA can only take action on concerns that relate to our regulatory responsibility. Read more about what TEQSA can take action on and can’t take action on. If there is an immediate personal threat or an individual has been a victim of harm, you should first contact the police. You may then follow this process to raise a concern with TEQSA. Describe your concern Provide as much detail as possible. Useful information includes the nature of your concern and potential consequences; relevant events, dates, and names of people involved; documents, evidence and communications that relate to your concern. Name of the course of study that is relevant to your concern (as applicable) Name of the campus location that is relevant to your concern (as applicable) Do you wish to upload any files that relate to your concern? Yes No This may include documents, evidence and communications that relate to your concern; copies of relevant policies or procedures; evidence of the outcome of any complaint and appeal processes. If you experience technical issues uploading files, you may also email them to concerns@teqsa.gov.au Upload a file Files may take about one minute to upload.Maximum 3 files.10 MB limit.Allowed types: gif, jpg, png, doc, docx, ppt, pptx, xls, xlsx.30 MB limit per form. Have you raised the concern with the provider? Yes No Please refer to our Before you raise a concern page. Describe the steps you have taken to resolve your concern with the provider If you have accessed the higher education provider’s formal complaints handling process, provide detail on the status and outcome. Have you sought an independent, third party review? Yes No Describe the detail of any third party review or other steps you have taken to resolve your concern If you have opted for an independent, third party review, provide detail, including the name of the third party, the status and outcome. For all other instances, provide detail on what steps you have taken to resolve your concern. Please refer to our Before you raise a concern page. Consent to disclose to another government agency (where applicable) Referring your concern to another agency will involve disclosing your personal information to that agency. By agreeing to TEQSA referring your concern to another agency, you consent to TEQSA disclosing the personal information in this form to that agency. If you do not agree to TEQSA referring your concern to another agency, TEQSA will not be able to send your information to another agency best placed to consider it. Do you consent to TEQSA referring your concern to another agency (where applicable)? Yes No Consent to disclose to the higher education provider (where applicable) Your information may be disclosed to the higher education provider in order to investigate the subject of your concern. Part G of TEQSA’s Complete APP Privacy Policy and Privacy Management Plan details how TEQSA deals with the personal information we receive in relation to concerns. If you do not consent to TEQSA disclosing your personal information to the higher education provider, TEQSA may not be able to investigate the subject of your concern. Do you consent to TEQSA disclosing your personal information to the higher education provider? Yes No Are you 18 years of age or over? Yes No The material in this form is true and correct to the best of my knowledge and belief. I understand that giving false or misleading information is a serious offence. Yes
