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* 1. Date

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* 2. Is your feedback in the form of a complaint or suggestion? State below

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* 3. Outline your response for Question 2 below.

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* 4. Please indicate, without prejudice, what outcome or further action you are expecting

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* 5. If you have written a formal letter in regards to your feedback to anyone else in the University please indicate.

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* 6. I declare that the information given is true.

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