ATENEO LAW SCHOOL

Rockwell Center, Makati City

APPEAL FORM
(With recommendation of the Students Appeals Committee)

I. PRELIMINARIES
APPELANT’S NAME: ____________________________________ STUD. NO: _______
CONTACT NUMBER: ____________________________________ YEAR and SEC: ____

II. SUBSTANTIVE MATTERS

SUBJECT APPEALED and SECTION: _________________________________________
PROFESSOR: __________________________________________________________
___________________________Semester _________________________School Year

BREAKDOWN OF GRADE
Recitation ________ Midterm Grade ____ Final Exam _______ FINAL GRADE _____
Other Basis Declared by the Professor: ______________________________________

GROUNDS FOR APPEAL

[ ] Mathematical Error in Computation of Grades

[ ] Manifest Oversight in Correction of Written Examinations

III. BACKGROUND DATA

PRESENT STATUS: [ ] REGULAR [ ] PROBATION [ ] FOR DISMISSAL
STATUS in the APPEALED SEMESTER
[ ] REGULAR [ ] PROBATION

QPI in the APPEALED SEMESTER: __________

SCHOLAR: [ ] YES [ ] NO
SUBJECT WITHOUT GRADES YET
____________________ unit (s) ____________________ unit (s)
____________________ unit (s) ____________________ unit (s)
OTHER SUBJECTS FAILED THIS SEMESTER

____________________ Grade: _____ ____________________ Grade: _____

____________________ Grade: _____ ____________________ Grade: _____

PAST ACADEMIC PERFORMANCE

QPI in the Previous SEMESTER: _________
ON PROBATION LAST SEMESTER: [ ] YES [ ] NO
ON PROBATION ANYTIME BEFORE LAST SEMESTER [ ] YES [ ] NO

_______________________________
SIGNATURE OF APPELANT STUDENT

IV. SAC CERTIFICATION

The STUDENTS APPEALS COMMITTEE has reviewed the appeal of the above-indicated
appellant student and

[ ] DENIED for reason that ____________________________________________

[ ] Recommends that the same be given due course

______________________ ______________________
CHAIRMAN REVIEW HEAD
Date: Date:
1
 ATENEO LAW SCHOOL
Rockwell Center, Makati City

APPEAL FORM

V. ACTION SECTION

1. Action by the Standards Committee

[ ] DENIED
Reasons: _____________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

[ ] REFFERED TO PROFESSOR _______________________________________

DATE: ________________________

2. Action by Professor
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

3. Final Recommendation of the Standard’s Committee

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

By:

ATTY. JACINTO D. JIMENEZ _______________________

Chairman Member

Date: _________________ Date: _________________

4. Action of the Dean

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Date: _________________
2