Academic Appeal Application Form (continued)

Academic Appeal Form

  • Use this form if you believe you have grounds for appealing against a decision made by a Board of Examiners, or other academic body responsible for decisions on student progression, assessment or award. See Section 2 for eligible grounds for appeal or consult Senate Regulation 10: governing student appeals
  • Information about the deadline for receipt of an appeal can be found in the University’s correspondence formally notifying you of the examiners’ decision or via the University’s Appeals webpages
  • Appeals submitted after the deadline will be deemed to be out of time and will not be considered unless you submit clear documentary evidence to demonstrate that you were prevented from submitting the appeal by the deadline;
  • You are advised to consult Academic Appeals: A Guide for Students before completing this form (this Guide can also be found on the Appeals webpages). Advice about the appeals procedure and making your case can be obtained from the Advice Service (formerly the Education Unit), Students’ Union (+44 (0)116 223 1132, . Note that the Advice Service cannot complete this form on your behalf.

Section 1.Student Details

Student number: / Click here to enter text. / Title(Mr, Miss, etc) / Click here to enter text. /
First name(s) / Click here to enter text. / Family name/surname / Click here to enter text. /
Academic decision you are appealing against: / Click here to enter text. /
  • Course termination
  • lower award (than the one for which you registered)or degree classification
/
  • progress decision (e.g. Resit without residence)
  • Other (please specify)

Level of study (click box to select): / Type and mode of study(click box to select)
☐Undergraduate (e.g. BA, BSc, BEng) / ☐on Campus / ☐Full-time
☐Taught Postgraduate (e.g. MA, MSc, MBA) / ☐by Distance Learning / ☐Part-time
☐Postgraduate Research (e.g. PhD, MPhil)
Course name: / Click here to enter text. / Course start date (mm/yy): / Click here to enter text. /
UG students only: current year of study (e.g. 1st): / Click here to enter text. /

Contact details for correspondence relating to your appeal (note: most communication will be via email):

Email address(es): / University email / Click here to enter text. /
Alternative email (e.g. gmail) / Click here to enter text. /
Postal address: / Click here to enter text. /
Click here to enter text. /
Click here to enter text. /
Country / Click here to enter text. / Postcode/Zipcode / Click here to enter text. /
Telephone: / Click here to enter text. /

Section 2.Grounds for Appeal

You may only appeal on the following grounds[clickrelevant box(es) to select]:

  1. that there were circumstances materially affecting your performance, for which supporting evidence exists, which were not known to the Board of Examiners or other academic body at the time its decision was taken and which it was not reasonably practicable for you to make known beforehand

☐New evidence of significant mitigating circumstances (if you select this box, complete all boxes in section 3A);

  1. that there appears to you to be evidence that procedural irregularities in the conduct of examination or assessment procedures of such a nature as to create a reasonable possibility that the result may have been different if it had not occurred

☐Evidence of procedural irregularities (if you select this box, complete section 3B);

  1. that there appears to you to be evidence of prejudice or bias or lack of proper assessment on the part of one or more of the examiners

☐Evidence of prejudice or bias (if you select this box, please complete section 3C).

Section 3.Appeal Details

Use the relevant box(es) below toexplainin fullthe grounds on which your appeal is based:

  • Describe in detail the circumstances you wish to raise;
  • Identify the specific examinations/assessments affected and explain how they were affected;
  • Be specific about the dates of the circumstances upon which your claim is based;
  • Include documentary evidence to support your claim, where appropriate.

Failure to do so may result in your appeal not being considered.

  • Ensure you specify your preferred outcome.

Note: the boxes will expand to accommodate your text.

A / New Evidence of Significant Mitigating Circumstances(complete all boxes in this section)

Only complete this section if you have genuine new evidence

If you submitted evidence before the meeting of the Board of Examiners but believe it has not been adequately taken into account this is a potential procedural irregularity and you should complete box 3B.

(i)Detailed description of your claim

Click here to enter text. /

(ii)Relevant third party evidence to support your appeal
List the documents you are submitting with this form (e.g. medical certificate, death certificate). Documentary evidence should be scanned and submitted electronically wherever possible.

  • Medical evidence must be from a qualified medical practitioner
  • Evidence must be supplied in English. If the original is in another language, you must obtain and submit a certified copy in English.
  • The evidence should be dated.

Click here to enter text. /

(iii)Explanation of why it was not possible to inform your department about these circumstances before the Board of Examiners met and evidence to substantiate your claim. If there is no clear evidence for this your appeal may be rejected.

Click here to enter text. /
B / Evidence of Procedural Irregularity

A ‘procedural irregularity’ means that the examining and assessment process was not conducted according to the University’s approved procedures. Examples might include errors in an
examination question paper, or with the administration of an examination, or a failure to calculate the marks correctly, or to consider any mitigating circumstances submitted by you before the due date.

(i)Detailed description of your claim

Click here to enter text. /
C / Evidence of Prejudice or Bias

(i)Detailed description of your claim and substantiating evidence

You should bear in mind, however, that:

  • the University’s examinations of undergraduate and taught postgraduate students are conducted anonymously in order to prevent such occurrences;
  • the complaints procedure exists to be utilised in relevant cases and the Appeal Panel will wish to know why any long-standing problems have not been aired in this context.

Click here to enter text. /

______

Preferred Outcome

(i)Please provide details of your preferred appeal outcome.

You should bear in mind, however, that:

  • An appeal which seeks an outcome which is not permitted within Regulations will not proceed to a panel. The Regulationscontain rules and important information about being a student at the University

Click here to enter text. /

Section 4. Checklist

All appeals:Click box to select

☐I have read and understand the Appeal Regulationsand‘Academic Appeals: A Guide for Students’

☐I have provided on/with this form all the information that I wish the Appeals Panel to consider in relation to my appeal

Additionally for appeals on the grounds of mitigating circumstances (appeal ground A):Click box to select

☐I have explained and provided evidence, where appropriate, of why it was not possible to inform my department earlier about the circumstances I have described (i.e. why I missed its deadline for the submission of mitigating circumstances claims).

☐I have enclosed appropriate third party documentary evidence to substantiate my claim of mitigating circumstances. Note. Documentary evidence should be submitted electronically wherever possible.

Section 5. Declaration

By submitting this form: I declare that the above information is accurate and true; I confirm that the details of this appeal are complete and will be passed on to the relevant University staff considering my appeal; I confirm have included relevant third party documentary evidence to support my case (where applicable).

Section 6. Submission of your appeal form

Return your completed appeal form and supporting evidenceto the relevant address given below to be received before the expiry of the appeal submissiondeadline. Appeals should be submitted electronically wherever possible.

Deadlines for receipt of appeal applications are stated:

  • via the email sent to you fromthe Registry that formally notifies you of the Board of Examiners’ decision, and/or
  • on the University’s appeal webpages

All academic appeals
(except those by MBChB students): / MBChB students only:
Email to: / Email to:
Facilities to electronically scan hard copy documents can be found in various locations on campus, including the photocopying rooms in the David Wilson Library. The service is free of charge when sending to your university email account.
If electronic submission is not possible,
post to:
Quality Office
Student & Academic Services
Fielding Johnson Building
University of Leicester
Leicester LE1 7RH
UK
orhand-deliver to:
Main reception, Fielding Johnson Building
Mark the envelope:
‘Academic Appeal:
For the attention of the Quality Office’ / If electronic submission is not possible,
post to:
Mr David Parker
College of Medicine, Biological Sciences Psychology
Maurice Shock Building
University of Leicester
PO Box 138
LeicesterLE1 9HN
UK
or hand-deliverto:
Main reception, Maurice Shock Building
Mark the envelope:
‘Academic Appeal:
For the attention of MrDavid Parker
Appeal enquiries:
|
+44(0)116 252 2605 / Appeal enquiries:
| +44(0)116 223 1598

Page 1 of 5(all pages must be returned to request an appeal)