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 NRIC/Passport
Study No.
Email Contact Phone Contact

2. Details of Appealed Course

Course Code

Course Title
Academic Year &
Offering School
Term1 Taken
Course Instructor

Outcome of i) Course grade before review :

Review of Results 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
To indicate the specific semester/trimester/mini-term.
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 3. State clearly and concisely your reason for this appeal.
A decision to proceed with your appeal 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):

4. 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: _______________________________________
5. Notes
Please email your completed form, supporting documentation and payment e-receipt to the Office of Academic
Services at exam@ntu.edu.sg, 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 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 4 weeks of receipt of your application.
If you have any queries, please email to exam@ntu.edu.sg

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