Student Originated Request for Change of Grade form Page 1
Student Originated Request for Change of Grade
In accordance with Academic Policy AA-03-020 I am submitting this Student Originated
Request for Change of Grade. I understand that this form must be filled out on a
computer and printed out. No hand written requests will be accepted.
Deadlines: Appeals of fall semester grades must be submitted within the first two
weeks of the following spring semester. Appeals of spring and summer semester
grades must be submitted within the first two weeks of the following fall semester.
Student Name: _________________________________________________
Student ID Number: _____________________
Date of Request: _______________
Name of Course: ______________________________________________________________
Catalog Course Number and Section (e.g., NAU 101-3): ______________________________
Four-digit Course Number: ________
Semester and Year in which course was taken:
Instructor of Record: ________________________________________________
STCW Assessor (if different from instructor of record: ________________________________
Grade assigned: _______________
Grade requested: ______________
Reason for grade appeal (check all that apply):
Third Parties/Witnesses you intend to call who can support your case:
____________________________________________________________________________
Please attach the following documents:
A narrative description of the circumstances surrounding the assigned grade and why
you feel it was inappropriate. You must support your claim of instructor mistake/bad
faith/incompetence/unfairness and provide support for the grade or remedy you
propose.
