Southern Cross Institute (SCI)

Appeal Form
I. Personal Details

Student ID

Given Name(s) Surname

Telephone Number Email Address

Current Address

Course Major

This form should be used if you are dissatisfied with the outcome of the formal complaint. Your application will be
assessed in accordance with the Student Grievance Management Policy and Procedure.
Students who require assistance or advice regarding SCI’s student grievance management processes should contact
the Student Support Manager on campus in the first instance or send an email (admin@sci.edu.au).

II. Appeal

Please provide a brief description of the outcome against which you are seeking an appeal and what steps were taken
to resolve your grievance, including dates (Please provide any additional information that would assist us in processing
this application).

III. Supporting Evidence

Please outline the evidence that you have in support of your appeal (you should attach the Grievance Outcome Advice
Form if applicable and any additional documentation as necessary).

Level 2, 1-3 Fitzwilliam Street, PARRAMATTA NSW 2150 Australia

Phone: +61 2 9066 6902 Website: www.sci.edu.au/
TEQSA Provider No: PRV14353 CRICOS Provider No: 04078A
Appeal Form_v1.0
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IV. Expected Outcome Sought

Please briefly describe the outcome you would like, to resolve your appeal.

V. Student Declaration/Signatures

I declare that the information provided by me on this form is true. I have read and understood the information about
the grievance management procedure as outlined in the Student Grievance Management Policy and Procedure. I agree
and give my consent to SCI to release my personal information for the purpose of resolving this appeal.

Student Signature Date

Official Use Only

Received By Name Signature Date

Reviewed By Name Signature Date

Outcome (including reasons) (please attach any relevant documents and additional pages if necessary)

Dean Date
Signature

Email

Level 2, 1-3 Fitzwilliam Street, PARRAMATTA NSW 2150 Australia

Phone: +61 2 9066 6902 Website: www.sci.edu.au/
TEQSA Provider No: PRV14353 CRICOS Provider No: 04078A
Appeal Form_v1.0
Page 2 of 2