Academic Appeal Form

ASSESSMENT APPEAL FORM

Section 1- Student details

Full Name:

Student Number:

Programme:

Year/Level of Study:

Contact Address:

Telephone Number:

Email Address:

I confirm that, to the best of my knowledge, the information given on this form is a true and
accurate statement of my exceptional personal circumstances. I accept that a false claim may
result in disciplinary action being taken against me.

Signed: Date:

Section 2 Appeal Details

Description of your Appeal
Describe in detail on the appeal that you would like to raise and be precise about the dates of the
circumstances upon which your claim is based

Favoured Outcome
Details of the reason why you believe that your request should be granted. (i.e I was
hospitalized)
Note- An appeal that seeks a result that is not permissible under the regulations will not be heard
by a panel.
Academic appeals are entertained only on the following Grounds:

● Administrators Error

● Medical Grounds
Evidence to support your appeal
Attach the necessary documents. Documentary evidence should be scanned and submitted
electronically wherever possible. (i.e. Medical form)

● Medical evidence must be from a qualified medical practitioner

● The evidence should be dated.

Section 3 Declaration

I declare that all the information and the evidence that I have provided above are genuine and
accurate;
I confirm that I have read through the Academic Appeal Policy manual and provide information
to be shared for the purposes of the provision of student support.

Date Student Sign

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Section 4:
For Administrative Use Only

Date received:

Date considered:

Decision: ACCEPT / REJECT (delete as appropriate)

Recommendation to
Examining Board:

To be signed and Signed:

dated by the
Academic Council
Date:

Date of notification of
outcome to student: