Pasadena City College
Dean's Response to Student Grade Appeal
Your response to the following questions will help to clarify the issues involved in this grade appeal. You
may continue on additional sheets of paper if necessary and attach supporting documentation.
Student Name:
Instructor:
Class:
Last M.I.
First
Division:
Section #: Semester Taken
Date:
Please give a brief summary of your attempts to resolve this matter
What is the student's position at this point?
What is the instructor's position at this point?
What do you believe would be a fair resolution to this matter?
I hereby certify that this statement contains a complete, accurate and truthful statement of the facts in this
matter and that the matter is currently unresolved for the reasons stated above.
Dean's Signature: Date Signed:
In order for the Vice President of Instruction to respond to the student within the established deadline,
please return this completed form within 10 class days to room C231.
Rev 11/2011
1 of 1
Appendix B3
