ࡱ> lk|s bjbj\\ `6ij6ij 4h?T 0^GGGGG" t$!<///////k2!5`/`!""`!`!/GG/,#,#,#`!FGG/,#`!/,#,#r,Z-G !v,//0 0,5"5Z-Z-5X.D`!`!,#`!`!`!`!`!//"`!`!`! 0`!`!`!`!5`!`!`!`!`!`!`!`!`! i:  CONFIDENTIAL Queens University Belfast Risk Assessment Appeal Form This form is for students appealing a decision of the Risk Assessment Panel under the Universitys HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/InterimMeasuresRegulations/"Interim Measures Regulations, to: Impose a precautionary suspension; Impose a placement suspension; or Withhold the academic award. Please read the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/InterimMeasuresRegulations/"Interim Measures Regulations and the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/InterimMeasuresProcedure/"Interim Measures Procedure which outline the process for appealing the decision of a Risk Assessment Panel. You must: Complete all sections of this form fully. Select the ground(s) on which you are appealing. Attach the evidence in support of your appeal and list where indicated. Evidence submitted after the deadline may not be considered. Submit this form within five working days of the Risk Assessment Panel outcome. Send the form to the Appeals, Conduct and Complaints Team HYPERLINK "mailto:appeals@qub.ac.uk"appeals@qub.ac.uk. You are strongly encouraged to seek advice and guidance from HYPERLINK "http://www.qubsu.org/AdviceSU/Academic/"SU Advice. Support is also available from the HYPERLINK "/directorates/sgc/wellbeing/"Student Wellbeing Service. Section 1: Your Details Full Name: Student NumberEmail address   Section 2: Decision which you are appealing Decision Please Select Precautionary suspension imposed Placement suspension imposed Academic award withheld Please note: you should attach a copy of your Risk Assessment Panel Decision Letter.Date of the Risk Assessment Panel decision: Section 3: Grounds of appealPlease consider carefully the ground(s) on which you wish to lodge an appeal and indicate as appropriate. An appeal will NOT be considered unless it is made on one of the permissible grounds as follows: Substantial and relevant new evidence has become available which the Responding Student could not reasonably have obtained in time to present to the Risk Assessment Panel, which has had a material effect on the outcome, making it unsound.There is evidence of a procedural irregularity in the conduct of the Risk Assessment Panel, which had a clear and demonstrable impact on the decision.Please give full details of the circumstances relevant to the ground(s) of the appeal. Please continue on a separate sheet if required. Section 4: Outcome sought Please state the outcome you are seeking from the appeal. Section 5: EvidencePlease list the evidence submitted in support of your appeal. Please note that any evidence which is not in English must be accompanied by a translation.  Section 6: Declaration By signing this form you are declaring that: you have read and understood the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/InterimMeasuresRegulations/"Interim Measures Regulations and the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/InterimMeasuresProcedure/"Interim Measures Procedure; to the best of your knowledge, this form contains a complete, true and accurate account of all the factors and details relevant to your appeal. Please note that fabrication or falsification of evidence or information provide to the University may result in action being taken under the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/Conduct/ConductRegulations/" \l "d.en.3013898"Conduct Regulations; you consent to this information and supporting evidence being disclosed to the members of staff involved in the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/"Interim Measures Regulations and Procedure; in some circumstances, it may be necessary for the University to disclose this information to a third party such as a placement provider; you consent to this information being shared in such circumstances; and you are fit to engage with the HYPERLINK "/directorates/AcademicStudentAffairs/AcademicAffairs/GeneralRegulations/AppealsConductandComplaints/InterimMeasures/"Interim Measures Regulations and Procedure. If you believe that you are not fit to engage, you must contact HYPERLINK "mailto:appeals@qub.ac.uk"appeals@qub.ac.uk. Provided that the information has not already been disclosed as set out above, if you wish to withdraw consent to any information being disclosed to relevant staff, you may do so at any time by sending an email to  HYPERLINK "mailto:appeals@qub.ac.uk" appeals@qub.ac.uk.. Section 7: Using Personal Information The information you provide is to facilitate your appeal in line with the Interim Measures Regulations and Procedure. Our lawful basis to process your information is under Article 6(1)(e) completion of a public task. We will hold your information securely and in line with our retention schedule.To find out more about how we manage your information and your rights please visit HYPERLINK "/privacynotice/OtherAreas/ListofOtherPrivacyNotices/PrivacyNotice-General.html" \t "_blank"/privacynotice/OtherAreas/ListofOtherPrivacyNotices/PrivacyNotice-General.html By submitting this form, you are giving us permission to perform these actions. 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