ࡱ> bgai bjbj^^ V<j<j 4hDcS-^&t<,,,,,,,/g2`,, - F, , r)*䎬#0*,#-0S->*22**2+, ,,, S-2 Y 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 Tick Precautionary suspension imposed Placement suspension imposed Academic award withheld Please note: you should attach a copy of the letter notifying you of the Risk Assessment Panel decision you wish to challenge.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 been 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.  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; you consent to this information and supporting evidence being disclosed to the members of staff involved in the Interim Measures Regulations and Procedure; 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.. 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