AUArts SA Student Action Form

CONFIDENTIALITY NOTICE

This form will be submitted to both the AUArts SA Vice-President Academic Affairs and AUArts Student Services. If you wish to remain anonymous and do not indicate your name in the submission, no direct action can be taken by AUArts SA or the University and the submitted form will be collected for documentation purposes only. Please note that you may be contacted regarding any follow-up questions we have in resolving this issue, and that your information will be kept in the utmost confidence when dealing with this matter. You will not be identified to the involved parties by AUArts SA or the VP of Student Affairs without your prior consent, however confidentiality cannot be assured in such circumstances where:

- An individual is at imminent risk of self-harm;

- An individual is at imminent risk of harming another, and/or;

- There are reasonable grounds to believe that others in the community may be at risk of harm

In which case information would only be shared with necessary services to prevent harm, and the name of the involved persons would not be released to the public.

IMPORTANT
Any incidents that directly involve the health and safety of any member or area of the University must be recorded in an incident report through the AUArts Security Office.

Do you wish to submit this form anonymously?

Yes No

Name

First Name Last Name

E-mail

Major

Year of Study

Time of incident

: Hour Minutes AM/PM Option

Date of incident

Month Day Year Date Picker Icon

Location

Who Was Involved

Student Staff Technician Faculty Administration Other

Description of Issue

Please make sure to note all relevant details including but not limited to: course name, faculty name, program area, location of service center.

Action Requested

Please indicate the desired action you would like the receivers of this form to take. ie. for information/documentation only, procedure changes, policy developed etc.

AUArts SA Student Action Form

Details