Appendix F - Professor Grade Appeals Form

Professor Information

Name ______________________________________

Campus Address                                                                         

Office Phone _______________________________________

Department                                   

Course Information

Course Number & Title                                                                     

Semester                     Student’s Name                                            

Number of class/lab meetings or clinical hours per week               

Number of student absences                          

Grade given in course

Date of meeting with student about grade

Was a change of grade requested?              Yes                  No

Basis of Grade Appeal Request:

      Personal Bias       Arbitrary Grading        Clerical Error

Please attach a separate sheet explaining any discussions with the student about his/her class performance prior to the granting of the disputed grade and during the meeting to discuss the grade, and the outcome of the meeting with the student.

Provide documentation of the student’s class performance, including in laboratory portions of the course if applicable.

Include copies (not originals) of:

1. Syllabus and other course materials
2. All tests, assignments, paper requirements, preceptor evaluations, etc.
3. All of the student’s work still in your possession
4. Any other pertinent materials or information

Professor Signature                                                    Date                 

This form is to be filed with the department chairperson no later than one week after receipt of the student’s form. Please retain copies of all information filed with this statement.