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This form must be returned via email to the Student Business Centre (sbc@bond.edu.au) by the due date as
advised on your exclusion notification. Late applications may not be considered by the Decisions Review
Committee (Exclusions).
You must complete all THREE sections.
1. STUDENT DETAILS
STUDENT NUMBER FAMILY/SURNAME GIVEN NAMES
CONTACT TELEPHONE (Business Hours): ........................................................................................
EMAIL ………………………………………………
2. PROGRAM DETAILS
DEGREE CODE DEGREE NAME
A. PROPOSED SUBJECT ENROLMENT
Subject Code Subject Title
Have you discussed this request with the Associate Dean (students) in the relevant Faculty? YES
NO (please tick one)
Application to Decision Review
Committee (Exclusions) to appeal
against Academic Exclusion
Received Student
Business Centre
3. DOCUMENTS IN SUPPORT OF APPEAL
You must attach the following in support of your appeal:
• A personal statement (no longer than 2 A4 pages) describing the circumstances that have contributed to your poor
academic performance, and the strategies you will undertake to ensure your success
• Any supporting documentation such as medical certificates, legal documents etc.
BY SUBMISSION OF THIS FORM YOU ARE REQUESTING AN APPOINTMENT WITH THE DECISION REVIEW COMMITTEE
(EXCLUSIONS). IF YOU ARE REQUIRED TO PRESENT TO THE COMMITTEE, THE STUDENT BUSINESS CENTRE WILL EMAIL
YOU CONFIRMATION OF YOUR APPOINTMENT. THE COMMITTEE WILL CONVENE AT 9AM FRIDAY OF WEEK
1 AND WEEK 4. THE MEETING WILL BE CONDUCTED REMOTELY AND YOU WILL BE PROVIDED WITH INSTRUCTIONS ON HOW
TO CONNECT ONLINE.
Student Declaration:
The information I have provided is true and correct. I understand and agree that if I am permitted to continue enrolment at the University, I
must abide by the conditions outlined by the Bond University Decisions Review Committee (Exclusions).
STUDENT’S SIGNATURE: ....................................................................Date: ....................................................
