Student Academic Concerns Reporting Form

Background Information

Students who choose to appeal the grade in a course or decision made by a course instructor or program coordinator/director must initiate the appeals process no later than 2 weeks from the occurrence of the concern. A student is encouraged to talk to their academic advisor or Dean of Students to clarify the steps of the resolution process. In the event of a program dismissal, students are encouraged to reach out to an academic advisor or Dean of Students to review NMC’s Progression Policy and clarify next steps.

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Your full name:

Your grade level:

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(1st yr, 2nd yr, 3rd yr, 4th yr, Graduate)

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Location of incident(Required):

This field is required.

Course Name & Number:

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e.g. HUM 150

Involved Parties

Name or Organization

Select Role

Phone number

Email address

Questions

Student shall communicate the concern with the involved individual (e.g. faculty member, program director or Academic Dean) to resolve the concern. If academic concern is not resolved to the reasonable satisfaction of the student, the student may file a formal academic concern complaint.

The first step in resolving an academic concern is to discuss the issue with the instructor. Have you communicated your academic concern to the involved faculty member?(Required)

Yes No

This field is required.

Please provide a detailed description of your academic concern using specific, concise, objective language (who, what, when, where, why, and how).(Required) This field is required.

What steps have you taken up to this point to try to resolve this academic issue? Please describe in detail.(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission