Name:

Email:

Phone:

Date of Appeal:

Module(s) being Appealed:

Assessment Period:

Deadline for Receipt of Appeal:

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Authenticator’s Comments provided for Results Approval Panel:-

[Enter comments made by External Authenticator in regard to down-grading/modification of result(s) here]

Reasons for appeal:-

[Enter comments made/reasons given by the Learner in regard to down-grading/modification of result(s) here]

Note:-

[Enter any relevant notes in here]