Ombudsman Western Australia

Your public education provider

Which college / school / university are you complaining about?

Name:*

Campus:*

What is the name of the course in which you are enrolled? *

What is your Student ID Number? *

Have you lodged an internal appeal with your college / school / university?*

Yes No

If your answer is No, please contact the international student advisor at your college / school / university before submitting this form.

Your Contact Details

Please provide us with your contact details below. Please note that your name and address must be provided in order to submit your complaint.

Surname:*

Given Name(s):*

Title: Mr Mrs Miss Ms Master Dr Other Select a title

Other Title (please specify):

Pronouns: he/him/his she/her/hers they/them/theirs Prefer not to say Select your pronouns

Your email address:*

Street/Postal Address:*

Suburb:*

State: select a state WA ACT NSW NT QLD TAS SA VIC Outside Australia

Post Code:*

Home Telephone:

Mobile Telephone:

Representative's Contact Details

If you want someone to represent you regarding your complaint, please give us their contact details below.

Surname:

Given Name(s):

Title: Mr Mrs Ms Miss Master Dr Other Select a title

Other Title (please specify):

Pronouns: he/him/his she/her/hers they/them/theirs Prefer not to say Select your pronouns

Email address:

Street/Postal Address:

Suburb:

State: select a state WA ACT NSW NT QLD TAS SA VIC Outside Australia

Post Code:

Home Telephone:

Mobile Telephone:

Do you require help to access our services?

Do you have an ongoing disability that means you require assistance to access our services?

Yes No      

If yes, please tell us how we can assist you:

Do you need a translator?

Yes No

If yes, please tell us what language you require:

How did you find out about the Ombudsman?

Tell us about your complaint

Did your college / school / university warn you under what circumstances your enrolment could be terminated / excluded? *

Yes No      

Were you informed of support services available to assist you? *

Yes No      

Did you contact any of your college / school / university's support services for advice / assistance? *

Yes No      

Did your college / school / university refuse to process your appeal because it was not received in time? *

Yes No      

Supporting documentation

If you want to send a relevant document, you can attach a document to this form or send it by post, email or fax:

I am attaching a document to this form

Send this file:

Send this file:

Send this file:

Do you need to send us more than three documents? Yes No

If you need to attach more than three documents, please send your additional documents by email to mail@ombudsman.wa.gov.au and tell us in your email that you have submitted a complaint online.

I will be sending relevant documents that support my complaint by:

Post Email Fax

Other information about you

By filling in this information, you will be helping us ensure our services are available to all of the Western Australian community. The personal information you provide is confidential to our office. Any information we release will only identify groups to analyse access by different members within the community. The analysis will not provide any information about individuals. While we would appreciate your responses, you are not required to fill in this part of the form.

Date of birth:

Which gender do you identify as?

Male      Female      Non-binary Prefer not to say

In which country were you born?

Are you of Aboriginal or Torres Strait Islander origin?

No        Yes

What is the primary language spoken at home?

English    
Indigenous Australian
Other please specify:

Do you have an ongoing disability?

No        Yes

If yes, please indicate what your disability involves:
Sight
Speech
Hearing       
Learning
Use of hands / arms
Use of feet / legs
Long term medical, physical or mental condition
Other
please specify:

Submit your complaint

Please check that the details are correct. To clear all information, click on the 'Reset' button. If you are satisfied with your submission, click on the 'Submit' button to send us your complaint.