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* 1. Date

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* 2. Course Title

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* 3. Year of Study

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

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* 5. Outline your response for Question 4.

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

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

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

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