APPEAL FORM
 
Name of person requesting the appeal:
________________________________________________________
 
Address: ________________________________________________________
________________________________________________________
________________________________________________________
 
Tel:  ____________________________________________________
Fax: ____________________________________________________

Email:  __________________________________________________
 
Name and identification of module for which the appeal is requested:
________________________________________________________________________________________________________________
 
Although copies of all correspondence relating to the review and appeal should previously have been sent to the curriculum consultant, Heather Persons, please attach copies of all emails that were sent.
 
Dates of module activities ________________________________________________________
 
Date of email in which information on grade was sent  ________________________________________________________
 
Date of email in which a review of the grade was requested from the instructor
 
________________________________________________________
 
Date on which a reply to the review was sent by the instructor.  (Attach instructor response.) 
________________________________________________________

Reasons why the grade and the review are being questioned.  (This response should be no more than one page.)