Appeal Request Form – Faculty of Medicine (Undergraduate and Graduate Studies)

Student Information

First name: *

Last name: *

Student number: *

uOttawa email address: *

Level of study: *

Program of study: *

Details of the appeal request

Please select the type of appeal you are submitting:

Appeal of mandatory withdrawal from the program or faculty
Appeal for revision of grades

Mandatory withdrawal appeal section – Please indicate the term and year below:

Withdrawal term:

Year of withdrawal:

Grade appeal request section – To be completed for final grade appeals only:

Term of the course:

Course year:

Course code:

Course title:

Name of the professor or coordinator of the course:

Grade assigned:

Assessment being appealed (e.g., Final Exam, Major Assignment):

Grounds for the grade appeal:

Supporting Documents

Letter of appeal (max file size: 2 Mb):

Choose fileChosen file:

Medical certificate (max file size: 2 Mb):

Choose fileChosen file:

Course syllabus (max file size: 2 Mb):

Choose fileChosen file:

Additional supporting documents (max file size: 2 Mb):

Choose fileChosen file:

Confirmation

I confirm that the appeal request is valid and I accept the conditions outlined at the bottom of the page: *

I confirm

Please leave this field blank:

Terms and conditions for submitting the form

By submitting this request, you understand, acknowledge, and agree to the following statements:

- I understand that if my appeal is approved, it may have an impact on any scholarships and/or financial aid I have received. I accept the responsibility to consult the Financial Aid and Awards Service to understand these impacts before submitting my request.

- I understand that if my appeal is approved, it may affect my course sequence and my eligibility to continue in the program.

- By submitting this form, I confirm that the information provided is complete and accurate to the best of my knowledge.

- I understand that my request may require follow-up or additional information..