Grade Appeal Form
Date ____________________
Student Name ________________________________________ Student ID _____________________
Telephone ___________________________ ACC Email ___________________________________
Have you read the Grade Appeal Policy in the Catalog? YES _____NO ____
(If NO, please read the policy before completion of this form.)
Course Information (e.g. BIOL 1420.01) ___________________________________
Semester/Year (e.g. Fall 2019) ______________________
Faculty _______________________________________________________________
(first and last name)
1. Have you attempted to resolve the final grade dispute with the faculty member?
YES _____NO ____
(If you answered NO to the question above, please contact your faculty member and try to
resolve the dispute. The Dean cannot proceed until this attempt has been reasonably made.)
2. Date and method of last contact with the instructor of the course.
3. What was the outcome of the meeting with your instructor?
4. State specifically the grade that you received, the expected grade you feel you earned, and the
action that you would like to see taken.
