Appeal Form for Chemistry Module Tutorial Slot Name (as shown on Matriculation Card) Matriculation ID Module to appeal (one form for one module ONLY) Email e.g. WE3, Wed 3 – 4pm Appealing for the following tutorial slots: (list two in order of preference) Original tutorial slot (applicable if you’ve balloted successfully for a tutorial slot): Reason for appeal (e.g. outbid, clash with another tutorial slot) I have attached a printout of my official timetable to this form. I understand that the success of my appeal will be based on existing timetable clashes with other NUS modules I’m taking in the same semester, and subject to the available space in the tutorial classroom. _______________________ Date and Time For Official Use Time of submission Date of submission Initial of Staff _______________________ Name _________________________ Signature