Owens Community College
Academic Grade Appeal Form
Student Name ____________________________ OCID ___________________________________
Address ___________________________________________________________________________
Telephone Number _____________________________________ Date ________________________
Please Print Clearly or Type
I am requesting a review of my grade for the following (check) ____ course _____ assignment:
Complete one form for each course/assignment for which you are requesting a review:
Course and section number ____________________ Instructor: _____________________________
Credit Hours: ________ Term/Date Taken: Fall ________ Spring _________ Summer _______
Grade for course: ____________OR Grade for assignment being reviewed: _______
In compliance with the academic appeal procedure I have met with each of the following individuals
involved in the grade review process.
Informal Process:
Step 1: Meet with faculty member ____________________________ ______________
(Instructor name) (date)
Step 2: Meet with Department Chair ___________________________ _______________
(Department Chair’s name) (date)
Step 3: Meet with the School Dean ___________________________ _______________
(School Dean’s name) (date)
Formal Process – Informal process must be complete before the formal process with the Provost can
occur. Students should complete this form and submit it to the Office of the Provost for review.
Step 4: Submit written appeal and documentation to the Provost
I am requesting a review of my grade because (check one or all that apply):
_____ There was a computational error of my grade that the instructor refuses to correct.
_____ I was graded differently than was published in the syllabus/assignment.
_____ I was graded differently from my peers in the class.
Signature: __________________________ Date: ____________________
Attach a letter providing a full explanation as to why you are requesting a review of your grades. Attach all
supporting documentation that you wish to be reviewed in support of your request.