Dental Examinations Executive - Appeals Submission Form

Dental Examinations Executive - Appeals Submission Form
This form should be completed by Dental Examinations Executive candidates wishing to make an appeal. Candidates are advised to read the Appeals Policy and Procedure in advance of completing and submitting this form.

An appeal must be submitted no later than 30 calendar days after results are released to candidates.

Late appeals will only be considered where there has been a significant and evidenced delay to a candidate’s ability to submit in this timescale.
Section 1: Personal Details
Full name of appellant

First NameLast Name
Email address
example@example.com
GMC/IMC number (where applicable)
Candidate Unique ID (this was provided to you in your Exam Confirmation Letter)
Name of Examination
Date of Examination

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Location of Examination

Section 2: Ground of Appeal
Please outline which ground you are appealing on. Appeals may be made on one or both grounds.

Ground 1: Procedural defects or irregularities in the conduct or administration of the examination that impacted on candidate performance or result.

Ground 2: Defects or irregularities in the consideration of exceptional personal circumstances.

Please complete the section(s) below relevant to the ground you are appealing under. If you are applying under both grounds, please complete both sections.
Please select the grounds you are appealing on:
Ground 1 (Procedural defects or irregularities in the conduct or administration of the examination that impacted on candidate performance or result)
Ground 2 (Defects or irregularities in the consideration of exceptional personal circumstances):
Did you bring your exceptional personal circumstances to the attention of the Executive in advance of the examination in question? If no, please detail why you were unable to do so:

Section 3: Supporting Evidence
Are you submitting supporting evidence or additional documentation related to your appeal?
Please upload supporting evidence below:

Cancelof

Section 4: Special Category Data
You may feel that it is necessary as part of raising your appeal to provide information or supporting documentation that reveals special category data as defined by the UK General Data Protection Regulation. This includes but is not limited to personal data related to your racial or ethnic origin, sexual orientation, or health data. Our handling of all your data is detailed in our Privacy Statement, but we require your consent to process any special category data. We will only share this information as necessary for the investigation of your appeal.
Should be Empty:

Section 1: Personal Details