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Student Appeal Form
To be completed by student and submitted to the Executive Director, Registrar Services and International Education. If you require assistance completing this form, contact Student Services, Conestoga Students Inc. or the Registrar’s Office.

This is required field
  am submitting a request for a formal appeal.
I have read and understood the Academic Dispute Resolution Appeal Policy and Procedure.
Student #      

This is required field
Program   Term

Section 1: Academic Appeal
I am appealing an academic decision:

Course Number

Course Title

If you are submitting an appeal for a course grade and /or academic decision,

you must attach the documentation from Steps 1 and 2 of the informal process. In addition, you must attach a letter clearly stating the new and significant evidence you are bringing forward to support this appeal which was not considered in Steps 1 and 2. Use additional pages if necessary and attach all relevant documentation. (i.e.tests, assignments, labs, reports, documents and/or letters and memos, etc.) If the professor has retained any assignment or examinations, it is his/her responsibility to provide a copy for the review process. The supporting documentation you and/or your professor/academic chair provide here will be used throughout the appeal process. (No additional documentation will be accepted after submission or during the process.)
Section 2: Student Code of Conduct Appeal
I am appealing a sanction applied by the Adjudication Panel under the Student Code of Conduct Procedure. Please note that Short Term suspensions cannot be appealed.
Sanction Assessed

If you are submitting a Student Code of Conduct Offence appeal,

you must include copies of all documentation and communication provided to you from the Office of the Vice President, Student Affairs and the Adjudication Panel. In addition, you must attach a letter clearly stating the reasons why a formal appeal is being requested and the facts which you believe are relevant to the case.