Academic Appeal

Background Information

All Sections must be completed in full and the information provided must be accurate. This form is for current and former students who feel that they were evaluated unfairly by an instructor and wish to file an Academic Appeal (related to grades) or Academic Integrity Appeal (related to academic integrity violations). Please review the policy and procedures before submitting this form.

Student Name:

Metro State Student ID:

Phone:

Metro State e-mail Address:

Email address must be of a valid format.

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Personal emails not allowed

Status(Required):

This field is required.

Metroplitan State Affiliation(Required):

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Student Information

Metro State ID

Phone number

Email address

Address

Appeal Information

Course Information Please list Course Number, Section, and Title(Required) This field is required.

Instructor's Name Please list the instructor who taught the course.(Required) This field is required.

Additional Information What type of case is this?(Required)

Grade Appeal (for overall semester grade, individual grades are not appealable) Academic Integrity (related to academic integrity violation)

This field is required.

Have you discussed this matter with other Metropolitan State offices/individuals?(Required)

Yes No

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If yes, who? This field is required.

Please provide a brief outline of reason for requesting assistance from this office:(Required) This field is required.

Acknowledgement I authorized the Office of the Ombudsperson to access my record and contact other Metropolitan State representatives about my concern. I understand that the information I have provided is accurate and true to the best of my knowledge, and I acknowledge that by providing misleading information is in violation of the Student Code of Conduct policy.(Required)

Yes No

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Supporting Documentation

Please include a copy of your course syllabus, applicable assignments, emails, or other communications that support your appeal. 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

Student Information

Appeal Information

Supporting Documentation

Submission