INSTRUCTIONS
1. Provide a copy of the Fact Finding Summary to the student and to the faculty member. The student
and faculty member should sign Part A to acknowledge receipt of the Fact Finding Summary. (The
student and faculty member need not sign at the same time.)
2. After the student signs Part A, provide a copy of the signed form to the student.
3. After the faculty member signs Part A, provide a copy of the signed form to the faculty member.
Eastern Illinois University
Grade Appeal Policy
FORM 4
Receipt of the Fact Finding Summary and Request for Review by the Dean
Part A. Receipt of the Fact Finding Summary by the College Grade Appeal Committee
I hereby acknowledge receipt of the Fact Finding Summary by the College Grade Appeal Committee.
______________________________________ ______________________________________
Student Signature Date of Signature
______________________________________ ______________________________________
Faculty Signature Date of Signature
TO THE STUDENT AND FACULTY MEMBER: You may request review by the dean only by completing
and signing Part B. Request for Review by the Dean (below). You must return the signed copy of Part B.
to the Dean’s Office within five (5) working days of the date that you signed Part A.
If you do not sign and return Part B. within five working days, the grade appeal process automatically
terminates and the decision of the College Grade Appeal Committee becomes final.
Part B. Request for Review by the Dean
_____ I hereby request review by the dean. After reviewing the Fact Finding Summary by the College
Grade Appeal Committee, I request the dean to review the appeal solely for the purpose of
determining whether the committee failed to follow appropriate procedures, as described on the
attached. I understand that my signature below authorizes the dean to initiate the review and to
review all documents used as part of the grade appeal process.
Attach a brief description of the specific procedures of concern and why they are of
concern.
_______________________________________ ______________________________________
Student Signature (for student decisions only) Date of Signature
______________________________________ ______________________________________
Faculty Signature (for faculty decisions only) Date of Signature
Received by the Office of the Dean of ___________________________________________________
__________________________________________ ______________________________________
Signature of Person Receiving Request for Review Date of Receipt
