This report will remain confidential. We will only use the information you have supplied to put you in contact with the University’s Student Wellbeing Service. This does not initiate a formal complaints process. We will not disclose any personal or identifiable information to others unless we believe there is a genuine threat to a person’s health and safety.

The following options are also availabile to you:

Staff members

This form is for students only. If you are a staff member, the following options are available to you:

By submitting this form, you agree to the use of your personal information as detailed in the Privacy Notice.

I am a student

Provide dates, times and locations, if possible.

If you believe there was more than one reason, please choose what you believe to be the main reason and detail other elements in the text box on the previous page.

Faculty of Arts

Faculty of Life Sciences

Faculty of Engineering

Faculty of Health Sciences

Faculty of Science

Faculty of Social Sciences and Law

Professional Services


The following questions are optional. We monitor reports by these equality groups to inform our future work. For example, we might want to know how many female students have made a report in the last 6 months. We do not include any personal details in these monitoring reports.

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 be disabled within the definition of the Equality Act 2010?

By submitting this form you agree to the use of your personal information. If you would prefer not to provide this information using this form you can contact the Student Wellbeing Service on 0117 331 0419 (Monday–Friday, 9am–5pm).