Cabarrus College Academic Appeal Checklist
This form serves as College documentation of students’ grievances and a mechanism for tracking decisions made
during the appeal process. After each step, the student and his/her advisor should be given a copy of this form.
The original document and any supporting documentation should be forwarded to the Coordinator, Advising
and Student Success by the next business day.
Grievance – A complaint based on the belief that one has been treated unfairly.
Appeal – A request for a person of authority to review and possibly amend a prior decision.
Please Select one:
Appeal of Academic Policy Decision: Students with grievances concerning the administration of academic policy
including but not limited to Transfer credit evaluation, leaves of absence, academic freedom, course withdrawals, or
program dismissal, may file a formal appeal. To be considered, an appeal of academic policy must be initiated within
five (5) business days of the date of action or official notification of the decision.
Appeal of Grade: Student with grievances concerning any grade or believes instances of perceived unfair treatment
negatively impacted his or her grade, may appeal the grade. It is the intent of these provisions to guarantee fair procedure
rather than to interfere with the prerogative of the faculty to evaluate the quality of a student’s coursework.
Appeal of Academic College Dismissal: A student may appeal a dismissal from the college for academic reasons.
Step 1: Grievance
Student’s Name: Program:
Advisor’s Name: Date of the Incident:_____________
Faculty or Staff Members Named in the Grievance:
Grievance & Requested Outcome
:
(Additional pages and/or documentation may be attached.)
I met with the faculty or staff member with the following outcome.
(check one below)
My grievance has been satisfactorily resolved. (If satisfactorily resolved,
do not complete rest of form.)
I still have concerns and understand this form will be submitted on my behalf
to tohe Office of Student Success. I understand it is my responsibility to make
an appointment with the faculty/staff member’s supervisor within 5 business
days from today.
Student’s Signature
Faculty/Staff
Signature
Date
Student Affairs
Staff Initials &
Date Received
Comments:
For Office Use Only
Date Received by Faculty/Staff: _______________________Signature: _______________________________________
The original form is kept in the Office of Student Success. A copy may be given to the student, faculty, and staff.
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Step 2: Appeal of Grade
Comments:
Step 2: Appeal of Academic Policy Decisio
n
Comments:
I met with the Program Chair/Dean/designee with the following outcome. (check
one)
My concern has been satisfactorily resolved.
I still have concerns and will appeal by making an appointment with the Provost
within 5 business days.
Student’s Signature
Program
Chair’s/Dean’s
S
ignature
Date
S
tudent
Affairs
S
taff Initia
ls
&
D
ate Received
I met with the Provost or designee with the following outcome. (check one)
My concern has been satisfactorily resolved.
I still have concerns but understand that in academic matters, the decision of the
Provost is final.
Student’s Signature
Provost’s Signature
Date
S
tudent
Affairs
S
taff Initia
ls
&
D
ate Received
I met with the supervisor with the following outcome. (check one)
My concern has been satisfactorily resolved.
I still have concerns and will appeal by making an appointment with the Provost
within 5 business days.
Student’s Signature
Program Chair’s
S
ignature
Date
S
tudent
Affairs
S
taff Initia
ls
&
D
ate Received
I met with the Provost with the following outcome. (check one)
My concern has been satisfactorily resolved.
I still have concerns but understand that in academic matters, the decision of the
Provost is final.
Student’s Signature
Provost’s Signature
Date
S
tudent
Affairs
S
taff Initia
ls
&
D
ate Received
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Step 2: Appeal of Academic College Dismissal
I met with the Director, Student Records and Information Management.
(check one)
My concern has been satisfactorily resolved.
I still have concerns and will appeal by making an appointment with the Provost
within 5 business day.
Student’s Signature
Director, Student
Records & Info.
Mgmt. Signature
Date
Student Affairs
Staff Initials &
Date Received
I met with the Provost with the following outcome. (check one)
My concern has been satisfactorily resolved.
I still have concerns but understand that in academic matters, the decision of the
Provost is final.
Student’s Signature
Provost’s Signature
Date
Student Affairs
Staff Initials &
Date Received
Student Comments
Provost
Comments:
RE
FERENCE: Policy 02-17 Grading Policy
Academic Appeals
Revised 8.19.18
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