Scholastic Standards and Revision of Records Appeal

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Student Information:

Your name:

M# (Including M):

Phone number:

Email address:

Physical address:

Appeal Information:

What is the semester and year you are requesting a grade change for? (if multiple, submit form for each year and semester)(Required) This field is required.

What are the course codes you are requesting a grade change for? (i.e. ART 200, separate with commas if more than one)(Required) This field is required.

Requested grade for consideration? (i.e. F to a W, separate with commas if more that one)(Required) This field is required.

We will contact the instructor for further information if needed. Please list instructor(s) name and corresponding course This field is required.

Why do you believe the change should be made? (i.e. describe the extenuating circumstances involved, including the provision of specific, relevant dates)(Required) This field is required.

If your appeal is based on the fact you stopped attending but did not properly drop or withdraw, please indicate your last date of attendance. This field is required.

We usually reach out to instructors to see if they would support the grade change. Would you be alright with us sharing your extenuating circumstances if they ask?(Required)

Yes No

This field is required.

Do you receive VA education benefits?(Required)

Yes No

This field is required.

Supporting Documentation

Documentation supporting your request is encouraged. For example, if the extenuating circumstances involved a medical problem the student is obligated to provide evidence to the nature and severity of the illness (dated letter from the physician, insurance documents, etc.), but is NOT obligated to personally disclose anything about their medical condition if they elect not to do so. All documents are held in strict confidence unless a written request is received by the office. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Student Information:

Appeal Information:

Supporting Documentation

Submission