Appeals Form Centre No.*Centre Name*Qualification title or focus of the appeal*The cohort(s) and/or learner(s) affected by the appealEnter Cohort IDs or Learner Numbers. Please do not include learner names. Click + sign to add more rows. 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.