Appeals Form Centre No.*Centre Name*Qualification title or focus of the appeal*The learner(s) affected by the appeal*Click + sign to add more rows.Learner No.Learner Name Nature and detail of the appeal*Attach further evidence here (if applicable)Supporting evidence is attached?* Yes No If so, please specifyDECLARATION: I am satisfied that the information provided is accurate and fully supports the application* First Name Last Name Date* Date Format: MM slash DD slash YYYY Centre quality contact details*The quality contact will be emailed a copy of the information submitted in this form. Quality First Name Quality Last Name Centre quality email* At Gateway Qualifications we are committed to protecting the personal information we are trusted with and respecting the privacy of those whose information we hold. We process your personal data as set out in our Privacy Notice which we encourage you to read.