Academic Integrity Appeal Form - Registrar's Office

Student Information:

Student Name:*

Student ID:*

Contact Information During Term:

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Contact Information Outside of the Academic Year:

Please note that appeal may not be complete before the end of term.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email

Details of Decision You Are Appealing (Course Information):

Department*

Course Number & Section*

Term*

Instructor*

Grounds for Appeal:

Appealing on the Basis of:*

an error of fact
an error of process
sanction was inappropriate

The grounds for appeal are described in Carleton's Academic Integrity Policy. Please indicate the reason(s) for your appeal by checking the appropriate box(es) below.

Please provide a concise statement that identifies precisely the grounds for the appeal. For example, if you checked "error of fact" above, then you would provide an explanation what error of fact occured. Students are advised to consult either with the Ombudsperson or the Director, Student Affairs for assistance in completing this appeal documentation.*

Relief Requested:

What relief do you want from the Senate Student Academic Integrity Appeals Committee?*

Request for an Oral Hearing (optional):

The Senate Student Academic Integrity Appeals Committee (SSAIAC) holds both written and oral hearings. The Carleton Academic Integrity Policy explains when an oral hearing is necessary. The SSAIAC procedures explain how an oral hearing is conducted.

Do you have a preference for either a written or oral hearing?

oral (Even if it is requested, it may not be granted, so please ensure your written submission is complete and addresses all the bases for your appeal.)
written

If you requested an oral hearing above, please explain why. An oral hearing is held only where the Committee concludes that written submissions cannot provide an adequate basis for assessing the issues in appeal. Please explain why you believe a decision cannot be made on the basis of written submissions.

Please note: The Senate Academic Integrity Appeal Committee reserves the right to choose the format of the appeal hearing. Preference for an oral hearing does not mean that an oral hearing will automatically occur.

If you are close to graduating, does the outcome of this appeal have the potential to impact your graduation plans within the next 3 months?

Yes
No

A copy of the application will be forwarded to the Senate Student Academic Integrity Appeal Committee. The Committee may also forward a copy of the application to the person who made the original decision on your case.

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