Appendix GA12

EXTENUATING CIRCUMSTANCES APPEALFORM

Application for an appeal against the decision of an Extenuating Circumstances Panel

This form is to be used by a student who wishes to appeal against the decision of an Extenuating Circumstances Panel which has implications for a student’s progression, assessment and/or award.

Before completing this form, students should read the University’s Extenuating Circumstances Procedures, taking particular notice of the section Appeals against Decisions of Extenuating Circumstances andthe grounds on which an appeal may be made.

Students are reminded that the Students’ Union can be approached at any time for advice and support on any issue.

This form should be typed, or completed in black ink, and sent to the Academic Office (Ref: Extenuating Circumstances Appeal), to arrive no later than15 clear working daysafter official notification of the Panel’s decision.

Student Name:
Student Number:
Contact Address:
Contact Telephone Number:
E-mail address:
Programme of Study:
Level of study:
Award Title (e.g. BA, Diploma):
Faculty/School/Centre:
Campus:

This form is available electronically from the Academic Office web pages:

The University will normally acknowledge receipt of your appeal and provide you with any updates and an outcome by email; therefore it is important that you check your University and personal email accounts regularly.

What was the decision of the Extenuating Circumstances Panel as stated on the official notification?
(this box will expand as you type or you may attach additional sheets)
Which part of this decision do you wish to appeal?
(this box will expand as you type or you may attach additional sheets)
Indicate the grounds on which you are appealing (tick the relevant box[es] and complete the relevant section of the form):
There were irregularities in the conduct of the extenuating circumstances procedure, which are of such a nature as to cause reasonable doubt whether the Panel would have reached the same decision had they not occurred(please complete Section 1 below).
The Extenuating Circumstances Panel failed to take proper account of circumstances which might have had an adverse effect on your academic performanceor were not fully aware of all the details relating to particular circumstances (please complete Section 2 below).

Please note that appeals are not permitted on any other grounds.

Section 1
Please outline the nature of the irregularities in the conduct of the extenuating circumstances procedure, and why, in your opinion, the Panel would not have reached the same decision had those irregularities not occurred.
(this box will expand as you type or you may attach additional sheets)
Section 2
Please outline the extenuating circumstances of which, in your opinion, the Extenuating Circumstances Panel failed to take proper account or of which the Extenuating Circumstances panel were not fully aware. You should note the nature of the circumstances, how these circumstances affected your work, and provide verifiable independent supporting documentary evidence.
(this box will expand as you type or you may attach additional sheets)
If the Extenuating Circumstances Panel was not made fully aware of particular circumstances, you must provide an explanation of why this was so.

Supporting evidence: List and describe the documentation which you have attached in support of your statement (Please note that the University will NOT seek evidence on your behalf – it is your responsibility to do this).

(Please do not state that “xxx is available if needed” - If you list documentary evidence to support this appeal you are required to submit it or provide a date by which you will submit it).
(this box will expand as you type or you may attach additional sheets)

NOTE - THE ACADEMIC OFFICE MAYDISALLOW ANY APPEAL THAT IS INCOMPLETE, LACKS EVIDENCE OR DOES NOT MEET THE CRITERIA.

The information which I have provided is correct and complete to the best of my knowledge. I give my consent for this information to be disclosed to the relevant officers of the University who are responsible for considering extenuating circumstances appeals.Submitting false documentation or fraudulent information is a serious matter and could be dealt with under the Disciplinary Procedures or the Unfair Practice Procedures.The University reserves the right to check on the validity of the document(s) you submit or statements you make in this appeal.
Signature of Student: / Date:
Please tick this box if you wish the Students’ Union to be informed that you have submitted an appeal.
Note: details of the contents of the appeal will not be shared with the Students’ Union, but the Students’ Union will contact you to offer advice and support.
All communications relating to this appeal during its process must be in writing and either emailed or posted to:
(for post)
Academic Office
(Ref: Extenuating Circumstances Appeal)
University of Wales Trinity Saint David
College Road
Carmarthen
SA31 3EP / (for email)
Email:
(Subject: Extenuating Circumstances Appeal)
Please send your appeal to the correct address or it may delay the process of considering your appeal.

September 20151Extenuating Circumstances Appeal Form