Application for Appeal Against Outcome of Review

Application for Appeal against Outcome of Review

Please ensure that you have read and understood the Appeal against Outcome of Review before completing this form.

Please ensure the form is duly completed and signed before you produce it at One Stop @ SAC to make payment.

1. Personal Details

Name / Click the fields to enter text / Matric No.
Programme of Study / NRIC/Passport No.
Email Contact / Phone Contact

1. Details of Appealed Course

Course Code
Course Title
Offering School / Academic YearTerm[1]Taken
Course Instructor
Outcome of Review of Results / i)Course grade before review:
ii) Course grade after review:
Please provide details of your consultation with your mentor/course coordinator/School on the outcome of review below. Appeals with no evidence of consultation will not be processed.
(Max 600 Chars)

1. State clearly and concisely your reason for this appeal.

A decision to proceed with yourappeal will be made solely on the information and supporting documents you submit. Please note that only appeals with demonstrable evidence of procedural irregularities and/or biasness in assessment would be considered. You should substantiate your submission with reference to specific events and provide relevant documentary evidence where possible.(Attach a separate page for your reasons if the space below is insufficient)
(Max 700 Chars)
Please indicate no. of attached files (as supporting documents):

1. Declaration

a)I would like NTU to consider my appeal and declare that the facts stated and supporting documentation provided in this application are true. I understand and consent to:

• NTU’s need to handle personal details about me which could include sensitive information (e.g. health/wellbeing information) in order to evaluate my appeal effectively.

• NTU’s need to exchange information about my appeal with other relevant persons within NTU and external organisations.

b)I also understand that I may be required to present myself at a hearing. All hearing proceedings are confidential, and no information relating to the proceedings shall be disclosed, published or shared by the student or any attendee, except with the written consent of the Board or otherwise compelled by law. However, NTU reserves the right to disclose the same if it deems necessary. This includes but is not limited to situations whereby clarification of its position is needed at a public forum or in relation to legal action.

Name: ______Signature: ______

Date: ______

1. Notes

Please email your completed form, supporting documentationand payment e-receipt to the Office of Academic Services at , indicating “Appeal Against Outcome of Review for <course code>” as subject title. Payment of S$32.10 (inclusive prevailing GST) for each appeal is to be made at One Stop@SAC.
Please keep a copy of your completed form and supporting documents for your own reference. Your submitted documents will not be returned to you.
Please ensure that you keep us updated on any changes to your contact details to facilitate our correspondence with you.
Your application will be acknowledged upon receipt via email. You will be provided with an update on your application within 4weeks of receipt of your application.
If you have any queries, please email to

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[1] To indicate the specific semester/trimester/mini-term.