For Office Use Only:

Received By : Received On : Receipt No.:

Acknowledgment of receipt of Appeal Request

Student ID No. : Received On : Acknowledged By :

APPEAL REQUEST

NAME NRIC / PASSPORT NO. INTAKE / COURSE

:
(in full)

: :

DATE STUDENT ID

: :

I wish to request for an Appeal for : MODULE TITLE & CODE LECTURED BY: EXAM DATE PUBLISHED DATE

REASON

I understand that appeals must be based on material irregularities or errors and cannot be made against academic judgement. Signature : Date : Note: An appeal must be submitted within 30 days from the date of the published results. Kindly take note that you will be required to take the next resit opportunity unless you submit the deferment form & this has been accepted by us.

Officeuseonly: Administrator (Name) Coordinator Assigned 1st Marker 2nd Marker Date Report Date Given Date Returned Appeal Results Date Keyed into AA Docket No. Old Marks New Marks Signed Date Report Posted Successful / Unsuccessful

: : : : : : :

: : : : : :

Remarks

Issue 2.0 April 2010

App_Req