On behalf of a student

Students’ Dignity at Study Reporting Form: On behalf of a student

I want to report on behalf of someone else

This form is for the reporting of unwanted behaviours on behalf of a student.

Unwanted behaviours include incidents of bullying, harassment, discrimination, victimisation and/or sexual misconduct, where the person(s) involved is a member of the university community including a student, member of staff, a visitor or contractor.

You can also report in person should you choose.

The Dignity at Study Champions are based within the university’s student Wellbeing Service, The Life Lounge, Chancellors Building, Eagle Tower, T2. You can call in Monday-Friday 8:45am-5pm (excluding bank holidays)

Once you submit the reporting form, it will be reviewed by the Dignity at Study Policy Coordinator and/or the Dignity at Study Champions. When appropriate, we will then aim to contact the student, within 5 working days via telephone call to schedule an initial meeting with a trained Dignity at Study Champion. This meeting is a safe space for the student to talk through their experience and explore the support available to them, along with any options they may wish to consider going forward.

Please note:

The student can choose to withdraw from the Dignity at Study process at any time; however, once the report has been submitted, a copy will be kept on file.

Students who have experienced any unwanted behaviours from others outside of the University community, can find out more information about the support available, including external services and resources via our Student Safety webpage here: https://greatermanchester.ac.uk/student-area/student-safety

Privacy Notice

This form is for reporting concerns on behalf of a student.

Please note:

If you are submitting this form without the knowledge or consent of the person involved, we may not be able to take direct action or contact them.
If you have consent, please ensure the individual is aware that their information is being shared with the University’s Dignity at Study Champions.
We will handle all reports sensitively and in line with UK GDPR and the University’s Data Protection Policy. Any information provided will be stored securely and only shared with relevant internal and/or external services where necessary and appropriate.
We aim to respect confidentiality but may need to act on concerns to safeguard the student and/or others, if there is a risk of harm.
For full details, please see the university’s Student Privacy Notice.

Study Reporting Form

SECTION 1A: CONSENT

*Indicates a response is required

We recognise you may want to report something that happened to someone else. where possible, it Is best to have the person’s consent, but we understand that Is not always possible or safe.

*Has the person affected given you their permission to report this

Important Note:

If you have selected ‘No’ or ‘I’m not Sure’ you can still continue with this report. We will treat this information with great care, and won’t take any direct action involving the individual without first considering the privacy, safety, and wellbeing of all parties.

If you’d prefer not to provide any identifiable details at all, you can instead use our Anonymous Reporting Form here

SECTION 1B: REFERRER DETAILS (Your Information)

We may contact you to clarify details, offer support, or discuss next steps. Your details will be kept confidential and only shared with relevant staff involved in responding to the concern.

*First Name

Last Name

Student ID Number (if known)

*Relationship to the student

Your School/Department (if applicable)

*Mobile Number

*Email Address

SECTION 2A: STUDENT DETAILS

please provide as much information as possible about the person you are reporting for

Full Name

Student ID Number

Student Mobile Number

Email Address

Course of study

Year of study

SECTION 2B: ABOUT THE STUDENT

To help us better understand the context and provide appropriate support, we ask for some optional demographic information about the student you are reporting on behalf of.

Please only answer if you are sure about the information, and feel it is appropriate to share. Please select the ‘I am not sure’ option or leave the section blank if you’re uncertain.

All information will be treated confidentially, in line with the University’s Data Protection Policy and will help us better understand who is affected by unwanted behaviours, so we can develop better more inclusive support, and address any inequalities.

Your answers will not affect the outcome of the report or the support the student receives.

Age range

Gender

Is the student’s gender identity different from the gender they were assigned at birth?

Ethnicity

Religion or Belief

Sexual Orientation

Does the student have a disability?

The Equality Act 2010 describes a disabled person as:
“…anyone who has a physical, sensory or mental impairment, which has a substantial and long-term adverse effect on their ability to carry out normal day to day activities.”

*Do you consider yourself to have a disability, long-term health condition, mental health condition, or specific learning difficulty?

SECTION 3B: PERSON(S) INVOLVED (optional)

This section is about the individual(s) you are reporting on behalf of someone else.

Please share as much information as you can about the person or people involved in the concern. Any details you can provide will help us better understand the situation and consider appropriate next steps. If you don’t have all the details, that is ok, just let us know what you do know.

Person 1's name

Person 1 is

If Person 1 is a student, what is their course of study?

Please use this space to share any further details about person 1 that you would like us to be aware of

Person 2’s Name (if applicable)

Person 2 is

If Person 2 is a Student, what is their course of study?

Please use this space to share any further details about Person 2 you would like us to be aware of

Person 3’s Name (if applicable)

Person 3 is

If Person 3 is a Student, what is their course of study?

Please use this space to share any further details about Person 3 you would like us to be aware of

Name and details of any other Person(s) involved:

SECTION 3C: WITNESSES OR OTHER PEOPLE PRESENT

If anyone else was present, saw or heard what happened, or if the person you're referring spoke to someone shortly after the incident, please let us know who they are. This could include another student, a staff member, or someone else who is aware of what happened.

Sharing this helps us build a clearer picture of the situation. We may contact these individuals if appropriate and only to offer support or gather more information, where necessary.

Details of anyone else who may have seen or heard what happened

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Students’ Dignity at Study Reporting Form: On behalf of a student

Privacy Notice

Study Reporting Form

THANK YOU FOR COMPLETING THE DIGNITY AT STUDY REPORTING FORM

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University of Greater Manchester
Deane Road, Bolton, BL3 5AB.

Tel: +44 (0)1204 900 600

Email: enquiries@greatermanchester.ac.uk

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Featured

Browse your subject areas

Welcome to #UniAsItShouldBe

Studying at Bolton

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Find your course

Browse your subject areas

Welcome to #UniAsItShouldBe

Studying at Bolton

More

On behalf of a student

Students’ Dignity at Study Reporting Form: On behalf of a student

Privacy Notice

Study Reporting Form

THANK YOU FOR COMPLETING THE DIGNITY AT STUDY REPORTING FORM

Form submitted succesfully

myBolton

University of Greater Manchester Deane Road, Bolton, BL3 5AB.

Tel: +44 (0)1204 900 600

Email: enquiries@greatermanchester.ac.uk

Explore

Quick Links

Students & Staff

University of Greater Manchester
Deane Road, Bolton, BL3 5AB.