WARNING: Students must contact the instructor prior to completing this form. General Information:
Grade change appeal requests must be submitted to the appropriate Dean within one (1) semester of the student’s initial enrollment in the course. Request must be submitted in writing using this fully completed form, as referenced in the Academic Code of Conduct.

Date:
Student ID: W00
First Name:
Middle Initial:
Last Name:
Maiden Name:
Contact Email:

Course Information

Department: 
 
Course:
Section:
Course Title:
Intructor:
Please select the semester and year the course was taken:
Term(check one):
Year:
Grade received:
Grade you feel you should have received:
Did you contact the instructor?
Reason for requesting a grade change (attach additional docs if possible):