Conestoga Students Inc.

Student Advocate Support Request Form

Please provide your personal information, a brief summary of the reason for your appeal, and answer our screening questions to ensure CSI's Student Advocates will be ready to assist you!

Name(Required)

First Last

Conestoga Email Address(Required)

Student Number(Required)

What is your academic school at Conestoga?(Required)

What is the name of the program you are enrolled in?(Required)

Are you currently considering or in the process of filing an academic appeal at Conestoga?(Required)

What is the course name and course code that you are considering or filing an academic appeal for?(Required)

On what date (month, day, year) was your grade or academic decision first issued or posted?(Required)

For what reason are you filing your academic appeal?(Required)

What stage of the appeal process are you currently in?(Required)

Please note, a student should begin the appeal process at step 4 if they were: Issued an academic decision by the Executive Dean/Dean of their program of discontinuance; assessed a penalty under the Student Rights and Responsibilities Policy; or unable to meet the deadline as noted in Step 1 due to a documented medical condition/incident.

How would you like to receive support during your appeals process?(Required)

What is the desired outcome you hope to see by filing an academic appeal?(Required)

What has your attendance been in the class you are seeking an appeal for?(Required)

Please note, CSI does not communicate with Conestoga faculty.

Have you been removed from your program by a Dean / Executive Dean?(Required)

Yes

Have you submitted all of the required coursework to date required for the course you are seeking an appeal in?(Required)

Yes

Engagement Agreement for Academic Appeals

I acknowledge and agree to the below information outlined in the Engagement Agreement for Academic Appeals.(Required)

PLEASE READ THE FOLLOWING CAREFULLY. BY SIGNING THIS AGREEMENT, YOU ARE AGREEING TO RELEASE CONESTOGA STUDENTS INC. FROM ANY CLAIMS RELATED TO THIS MATTER AND WAIVING ANY LEGAL RIGHTS YOU MAY HAVE, INCLUDING THE RIGHT TO COMMENCE A LAWSUIT AGAINST CONESTOGA STUDENTS INC.

ENGAGEMENT AGREEMENT FOR ACADEMIC APPEALS
(the “Agreement”)

BETWEEN:
Conestoga Students Inc. (“CSI”) -and- [NAME OF STUDENT]

WHEREAS CSI is a not-for-profit corporation, duly incorporated under the Canada Not-for-profit Corporations Act (2009);

WHEREAS CSI provides its student members with guidance, education and advice through its academic appeals service;

AND WHEREAS the Student wishes to retain CSI to assist them with their academic appeal at Conestoga College, specifically for the matter described in the submitted intake form, dated as of today’s date.

NOW THEREFORE, in consideration of the mutual agreements contained in this Agreement and for other good and valuable consideration (the receipt and sufficiency of which are acknowledged by each party hereto), the parties agree with one another as follows:

1. CSI shall provide guidance, education and advice on the academic appeal process at Conestoga College to the Student (the “Services”). However, the Services shall be limited to guidance, education and advice only, and CSI shall not represent the Student throughout the academic appeals process toward the College.

2. The Student UNDERSTANDS that any advice provided by CSI may not be free of errors and omissions.

3. The Student ACKNOWLEDGES that College student academic appeals are unpredictable, that CSI does not control the appeals process and that CSI is not responsible for the outcome of any appeal process.

4. The Student UNDERSTANDS that an academic appeal must be commenced within 5 business days of receiving an academic decision.

5. CSI AGREES to make every effort to respond to the Student’s inquiry within 2 business days. However, CSI cannot guarantee a response in that time frame.

6. The Student AGREES that they should NOT delay in engaging CSI and that the Student shall NOT delay their appeals process because they are waiting for a response from CSI.

7. The Student ACKNOWLEDGES that they are responsible for conducting their own research on College student appeals and that they shall NOT solely rely upon CSI.

8. The Student CONFIRMS that they have read the following documents, created by Conestoga College:
a. the Academic Dispute Resolution and Appeal Procedure; and b. the Academic Dispute Resolution and Appeal Policy.

9. The Student ACKNOWLEDGES that for CSI to perform the Services, they may need to disclose to CSI confidential and/or sensitive information (the "Confidential Information"). Confidential Information shall mean all information disclosed by the Student to the CSI, which is non-public and either proprietary, personal information or confidential in nature. CSI shall only use the Confidential Information in furtherance of its performance of the student advocacy services, and not for any other purpose or for the benefit of any third party. CSI will safeguard the Confidential Information by requesting only relevant information that may be necessary to provide appropriate support and referral options. The Confidential Information shall be kept with CSI for 5 years after the Student’s file is closed. Thereafter, the Student’s Confidential Information shall be destroyed. If the Student has any questions or concerns about confidentiality and privacy, they may contact CSI at csi@conestogac.on.ca.

10. CSI reserves the right to stop assisting the Student if:

a. they fail to respond to CSI’s emails within 2 weeks;
b. they mislead CSI or act dishonestly; and
c. their actions do not comply with the College's Student Rights and Responsibilities.

11. The Student AGREES to treat CSI staff respectfully, as defined in the Student Rights and Responsibilities.

12. The Student further UNDERSTANDS that Academic Appeal Services is not responsible for a delay in the process and/or the outcomes of appeals if they breach their responsibilities under the Student Rights and Responsibilities, the Academic Dispute Resolution and Appeal Procedure or the Academic Dispute Resolution and Appeal Policy.

13. The Student AGREES to hereby release and forever discharge CSI, its parent, affiliates, subsidiaries, officers, directors, agents and employees from any and all claims, actions, liabilities, complaints and damages related to the Services, including any remedies which may exist in law including, without limiting the foregoing, any claim under the Negligence Act (Ontario), the Canada Not-for-Profit Corporations Act, the Human Rights Tribunal of Ontario or any other similar successor legislation, and at common law.

14. The Student ACKNOWLEDGES that they have had ample opportunity to review and consider this Agreement, that they fully understand the provisions hereof and have had the opportunity to seek legal advice in connection with this Agreement.

15. The Student and CSI AGREE that this Agreement shall be governed and construed in accordance with the laws of Ontario.

Name(Required)

First Last

Signature(Required)

Today's Date(Required)

Supports and Services That May Be Of Use to You

Academic Resources:
Academic Appeals Procedure at Conestoga Academic Appeals Policy at Conestoga Academic Integrity at Conestoga Guide to Appealing an Academic Integrity Violation Academic Incidents at Conestoga Academic Offences at Conestoga Academic Contacts (Department Chairs, Executive Deans/ Deans)
Additional Resources: Mental Health Supports at Conestoga Counselling Services at Conestoga Medical Care at Conestoga Tutoring at Conestoga Drop-In Academic Supports

Frosh Kit Update

Student Advocate Request Form

Student Advocate Support Request Form

Engagement Agreement for Academic Appeals

Supports and Services That May Be Of Use to You