Student Grade Grievance Appeal (Step 5) Form

Background Information

This form must be completed by the student who is filing the grade grievance.

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Time of incident:

Department of Course(Required):

This field is required.

Involved Parties

Enter your information and that of the course instructor.

Name

Select Role

ID Number

Phone number

Email address

Address

Detailed information

Provide specific course information, include department, number, section, and semester. Also provide a Case Number for your initial Grade Grievance if known.(Required) This field is required.

Has this been processed through the first four steps of the grade grievance process?(Required)

Yes No (If no, complete the first four steps of the process before completing and submitting this form.)

This field is required.

Give a brief but specific statement of grievance.(Required) This field is required.

Reasons for lodging the grievance appeal. Please reference supporting evidence which can be attached below.(Required) This field is required.

A specific proposed resolution for the grievance.(Required) This field is required.

Supporting Documentation

Attach all supporting documentation related to this grade grievance. You may attached zipped files if the originals are too large. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

Select from the list, any that you would like sent a copy of your initial form.

Student Association Ombudsman

Email me a copy of this report

Background Information

Involved Parties

Detailed information

Supporting Documentation

Select copy recipients

Submission