First Name:

Last Name:

Address:

Phone Number:

Email Address:

Please provide details of the complaint – dates, times, nature of the
complaint:

Please clearly state, if relevant, how you consider that the HEA standard of service was not met:

Please provide details of when you raised the complaint at point of service delivery and the outcome. If not raised at point of service delivery, please
advise your reasons for not doing so:

Please provide details of any HEA staff members involved:

What are you hoping to achieve e.g., an apology, explanation etc?:

Please attach copies of any relevant documents or correspondence: