This Expulsion Appeal Form should be completed by the student wishing to appeal an expulsion from a Victorian government school. The list below outlines what you need to do to submit an expulsion appeal.
⁃	You need to send this Expulsion Appeal Form to the principal via mail, fax or email. A copy   of this expulsion appeal form must be received by the principal within 10 school days of you receiving the Notice of Expulsion. 
⁃	You should contact the school to confirm they received this Expulsion Appeal Form. 
⁃	You should keep a copy of this expulsion appeal form for your records.
SCHOOL INFORMATION
School name		
School principal name		
STUDENT INFORMATION
Name		
Date of birth		Year level		
Age		VSN		
RELEVANT PERSONS DETAILS
Name		
Telephone		Email		
Relationship to student		
EXPULSION DETAILS
Date of expulsion		
BACKGROUND INFORMATION
Please provide a brief history of the circumstances leading to the expulsion.

	

REASON(S) FOR THE APPEAL
Was the Department’s expulsion process followed by the principal?
(For information on the process that principals are required to undertake to expel a student please see the Disciplinary Measures section of the Student Engagement and Inclusion Guidance. Please note that under Ministerial Order 625 principals are required to undertake tasks in the Guidance that say ‘must’. If a principal has not completed a task that says ‘should’, this is not grounds for an appeal.)	
	Yes	     No	
Please provide reasons for your answer.

Which components of the required process do you believe were not followed?

Do you believe that the grounds on which the expulsion occurred were unfair? 	
	Yes	       No	
Please provide reasons for your answer. 

If the student has a history of behavioural issues, do you believe that there were not sufficient prior interventions and strategies used prior to the decision to expel? 	
	Yes	      No	
Please provide reasons for your answer. 

Do you believe that there were other extenuating circumstances that should have been taken into account prior to the decision to expel? (tick one) 	
	Yes	      No	
Please provide reasons for your answer. 

	
OTHER RELEVANT INFORMATION
Do you have any other relevant information that you believe should have been considered prior to the decision to expel?
Please provide the additional information here.

	
Do you have any other relevant documentation that you believe should have been considered prior to the decision to expel? 
If there is additional documentation, please list it here. Please attach copies of this documentation to this Expulsion Appeal Form. 

	

Student name		
Signature		
Date		

Relevant person name		
Relationship to student		
Signature		
Date