UPDATED: June 11, 2019
Appeal of Final Grade to Vice Chancellor of Academic Affairs
To appeal the final grade in a course to the Vice Chancellor of Academic Affairs, if appeal has been
denied by the instructor of the course and the Division Coordinator. (Related Policy: Grade Appeals,
found in the 2019-2020 Catalog)
Student’s Name: Lola Number: ______________
Email Address: _____________________________________ Phone Number: __________________
What is your major?
AC & Refrigeration (HVAC) Industrial Maintenance Technology Patient Care Technician
Business Office Administration AALT/Louisiana Transfer Pipefitter Apprentice
Drafting & Design Technology ASLT/Louisiana Transfer Practical Nursing
Electrical Helper Medical Assistant Process Technology
General Studies Medical Coding Specialist Teaching (Grades 1-5)
Industrial Instrumentation Technology Welding
In what semester did you earn the grade you are appealing? _________________________
In what class did you earn the grade you are appealing?
Course Name: _____________ Instructor Name: _______________________
CRN #: __________________
On what grounds are you appealing this grade?
the instructor departed substantially from his/her previously articulated written standards, without
notifying students, in determining the grade
the instructor imposed criteria different from those used to evaluate the academic work of other
students in the class, as outlined in the course syllabus
the instructor made a calculation error and I have tangible evidence to support the claim that an error
was made
UPDATED: June 11, 2019
In the section below, provide your justification for why the appeal should be approved (attach any
supporting documentation):
Please confirm the following:
□ I have appealed to the Division Coordinator and he/she has denied my appeal.
Routing Instructions:
Completed forms can be either:
1. Printed and delivered to the Student Services Office at the Gonzales, Reserve, or Westside Campus; or
2. Emailed to academicaffairs@rpcc.edu
For Office Use Only (if report is hand delivered):
Date Received: __________________ Received By: _________________________
This form must be given to the Vice Chancellor of Academic Affairs.