TES Appeal Form

First Name*

Last Name*

Email Address*

Is this request in anticipation of a possible punitive or retaliatory evaluation for a poor trainee evaluation?*

Yes

If so, what is the name of the trainee?

What is the rationale or basis for requesting an investigation and appeal request? i.e., what specifically is being challenged? 200 words max.*

Please let us know your thoughts on possible reasons for the low scores. 200 words max.*

Is there any change in the way you will approach teaching and education going forward? 200 words max.*

Notes: A number of scenarios may account for an appeals request being denied, including, but not limited to:

A suspected resident not having actually submitted the challenged evaluation;
A challenged evaluation being deemed - on close examination - to be neither unreasonably negative nor punitive;
A challenged evaluation being deemed to be, in the Committee’s estimation, justifiable based on identified similar issues (as described) from historical trends data analyses.

More information on appeals may be found at http://www.deptmedicine.utoronto.ca/teaching-evaluation-scores.

Drop box for attachments: Please attach any documents that may be helpful for the committee to know (i.e: reprints from POWER, statement/letters of support, etc). Documents must be in PDF version and in the following format, "Last name, First name - document name."

Maximum 5 files.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

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Is this an urgent request?*

Please provide the reason for urgency