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The information on this form is collected under the authority of the BC Freedom of Information and Protection of Privacy Act (1996) and is needed to process
any changes in your student record. If you have any questions about the collection and use of this information contact the Registrar’s Office.
Please submit to the Registrar’s Office or the Continuing Studies Office (if a Continuing Studies course or program).
You will be notified of the decision in writing by mail.
Appeals will be reviewed by the appropriate departments.
All decisions are final.
Type of appeal
What policy does this appeal fall under? Policies can be found at
Course CRN Grade received
Documents attached: rYes, number of pages
Last name (family name) First name
City Province Postal code
Phone number Email
Student signature Date
Student ID
Personal information
Complete all sections that apply to your appeal
Student Appeal
p: 604.871.7000, option 4
f: 604.443.8450
Downtown campus
250 West Pender St., Vancouver, B.C. V6B 1S9
Broadway campus
1155 East Broadway, Vancouver, B.C. V5T 4V5
r R efund Appeal Policy
(once a refund appeal has been submitted you will be removed from the course or program)
r G eneral Appeal
(if your appeal does not fall under the policy above please select this option)
click to sign
click to edit
If more space is required, please attach additional pages.
Provide complete information, including any documents to support your request:
rApproved rDenied
Administrator signature Date
Reason for appeal
What action(s) would you like to see taken?
Office use only