Appeal Form

Appeal Form
Please submit the completed form together with any supporting documentation within seven working days of receiving an appealable decision. Refer to Appeals Policy for more information, including appealable decisions and grounds for appeal.
To: Academic Director
Your full name*

Legal First NameLegal Last Name
Your address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:

Area CodePhone Number
Email:
example@witt.ac.nz
I wish to appeal (tick one):

The outcome of an academic complaint or academic integrity matter or review processThe outcome of a non-academic complaintThe outcome of a postgraduate research or scholarship decisionThe outcome of an ākonga breach of discipline decision
The grounds for my appeal are as follows:
Please attach any supporting evidence. You may attach multiple files here.

Cancelof
What outcome are you seeking?
Signature

Clear
Support person:

First NameLast Name
Email:
example@example.com
Phone:

Area CodePhone Number
Academic Committee Resolution No:
Date

DayMonthYear
Date
Should be Empty: