Appeal Form

Student Appeal Form
This Appeal Form must be lodged directly to Student Services
Student Number
USI No
Name

GivenFirst NameFamily Name
Course Enrolled in:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Contact Phone
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Note:
1. This Appeals Form must be lodged no later than 20 working days after the date of notification letter
2. This Appeals Form must meet the grounds for appeal
3. Grounds of appeal documents must be attached
4. Original notification letter being appealed must be attached Type of Appeal (Please tick appropriately)
Type of Appeal
DETAILS OF YOUR GROUNDS FOR APPEAL: (Attach additional pages if required)
Attach additional pages if required.

Cancelof
Student Signature
Date

DayMonthYear
Date
Note: Commencement of process is within 10 working days of the formal lodgement of the appeal and reasonable measures are taken to finalise the process as soon as practicable.

Date created: June 2026 Heaton Institute of Technology I RTO No: 46474 I CRICOS Code: 04397H
Should be Empty:

Student Appeal Form