Appeal of Ethics Committee Decision Form Please enable JavaScript in your browser to complete this form.PERSONAL INFORMATIONStudent ID *Identity Confirmation – Birthdate *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name *FirstMiddleLastGender *FemaleMaleNon-BinaryLanguage preference for communication *EnglishFrenchPreferred Email Address *Alternate Email AddressPhone number to reach you *PersonalBusinessBothPersonal Phone *Business Phone *APPEAL OF DECISIONA holder may appeal and Ethics Committee Decision on the following three grounds: 1. made a significant and material error regarding its interpretation of the Code of Ethics, 2. made a significant and material misapprehension of the facts, or 3. imposed a penalty that is manifestly unreasonable in light of the proven facts. The request must provide a written submission stating the relevant reasons why the decision is not reflective of the situation, why the sanctions are unfair and the relief being requested. A request for an appeal must be submitted within thirty (30) days from the email receipt of the Ethics Committee Decision. The decision made on the date: *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920I request to appeal the decision for the following reasons: *Upload form and supporting documentation: * Click or drag files to this area to upload. You can upload up to 20 files. Appeal of Ethics Committee Decision Information Non-refundable fee charged per appeal : $200 plus applicable taxesPRIVACY POLICYI have read CSI’s Policies and Guidelines including the Refund Policy, Privacy Policy and Student Code of Conduct described on the website at www.csi.ca and agree to abide by the rules and regulations outlined in it. CSI’s privacy policy is designed to protect your personal information. This policy describes the personal information that CSI requires, how it will be used and under what circumstances it may be distributed to third parties. Very briefly, CSI needs to obtain certain information about you to enrol you in a course and to match your results to your academic file. Without it, we cannot accept you as a student as we wouldn’t be able to create a student record for you. We will ask for information such as your name, address and credit card number. We will only ask for the information we need, we will keep it safe and we will not sell or distribute it to anyone else. We may share it with our suppliers to better serve you, to compile records or to report to the regulators. We will not give any information to your employer unless you complete the information release consent form, or breach CSI’s Student Code of Conduct. By signing and submitting this document, I confirm that I understand and consent to the collection, use and disclosure of my personal information by CSI and I agree to abide by the CSI Student Code of Conduct.Declare *I confirm.Signature * Clear Signature Next