Evaluation Appeal Form

EVALUATION APPEAL FORM Teacher: Department: Date of Evaluation Being Appealed: Evaluator: Date of This Appeal: Appeal Deadline: ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ GROUNDS FOR APPEAL Please state the grounds on which you are appealing (tick all that apply): □ Factual inaccuracy in the evaluation record □ Procedural irregularity in the evaluation process □ The evaluation was discriminatory or biased □ Relevant evidence was not considered □ Other (please specify below) Provide a detailed explanation of your grounds for appeal: ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ SUPPORTING EVIDENCE List any evidence you wish to submit in support of your appeal: 1. [Evidence item] 2. [Evidence item] 3. [Evidence item] All evidence must be submitted by {{appeal_deadline}}. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ RESOLUTION REQUESTED What outcome are you seeking from this appeal? □ Withdrawal of the evaluation □ Revision of specific aspects of the evaluation □ Re-evaluation by a different evaluator □ Other: _______________ ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ DECLARATION I confirm that the information provided in this form is accurate to the best of my knowledge. Teacher Signature: _________________ Date: _________ Received by: [Principal Name] Date Received: _________ This appeal will be acknowledged within 5 working days and a panel hearing arranged within 15 working days.