Print this page out, fill out the form, attach it to the assignment or exam in question and turn it in to the instructor.

If this is a request for reappraisal of a group assignment, please include the name of each student in the group.

Date :

Surname :

Given Name :

Student ID Number:

UW UserID:

Names of Other Group Members (if applicable):

Contact Email :

Description of what you would like to have reappraised and why:

I understand that the entire body of work will be remarked and that the reappraisal could result in the mark being adjusted higher, lower or not at all.

Student Signature :