EXPLAIN GROUNDS FOR APPEAL IN DETAIL: (Do not leave blank. Add additional pages as needed to fully
explain your grounds of appeal.)
Note: You must also enclose a copy of the decision you are appealing and all other relevant documentation in support
of your appeal.
If the ground for appeal is new evidence, the new evidence must be described clearly, including the
names of any witnesses.
OUTCOME SOUGHT: (Do not leave blank)
IMPORTANT NOTE: The Code of Student Conduct states that an appeal panel may, in its discretion, hold an
oral hearing or make its decision solely on the basis of the written material filed by the parties, provided that it
shall hold an oral
hearing if a party satisfies it that there is good reason for doing so (Part L, s. 15). If you wish
an oral hearing,
please attach an additional page setting out your reason(s).
LEGAL COUNSEL: If you have retained legal counsel, complete the following:
Name of Legal Counsel:
Name of Firm (if applicable):
Address:
Telephone: E-mail address:
DOCUMENTATION (See Appeals, Procedures section in Part L of Code of Student Conduct)
An incomplete Appeal Application will not be accepted by the Secretary of the Board of Governors. A copy of the
decision being appealed and all relevant documentation in support of the appeal must be attached to the Appeal
Application. The Appeal Application must contain the grounds for the appeal, the outcome sought, and a full statement
supporting the grounds for the appeal. A completed Application for Hearing must be received in the University
Secretariat (address below) within two weeks after the issuance of the decision which is being appealed.
The Secretary of the Board of Governors will provide the Respondent with a copy of the Appeal Application and
attachments. The Respondent must file a written response within 10 days. A copy of the response will be provided
to the
Appellant who may file a reply within 10 days of receipt of the response.
* Appeals are heard by a panel of UDAC. A list of the current members of UDAC is available from the University
Secretariat.
SIGNATURE
I confirm that I have fully completed this Appeal Application and have attached all documentation that is relevant to
my appeal.
Date
Signature
OCT 2020
University Secretariat
4101 Stevenson Hall
The University of Western Ontario
London, Ontario N6A 5B8
Telephone: (519) 661-2055
E-mail: abryson4@uwo.ca
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