Fillable Student Final Grade Appeal Forms (fillable Forms) (Lone Star College System)

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Student Final Grade Appeal Forms (fillable Forms) (Lone Star College System)

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APPENDIX & FORMS
V.G. Student Final Grade Appeal Forms A-1
Form V.G.1.: Final Grade Dispute Form
Students who would like to dispute a final grade should use this form to initiate an academic
appeal. The completed form should be first submitted to the instructor of record for the
relevant course.
Student Name ___________________________________________ LSC ID No. ___________________________
Phone: ______________________________________________ E-mail: _______________________________________
LSC college ___________________________________ ________________________________________________________
Course title _________________________________________ Course No. ___________________________________
Instructor of Record _________________________________________________________________________________
Grade Received __________________ Semester and Year Grade Received ________________________
Grade Appeal Basis (check all that apply)
Mathematical Error in Grade Calculation
Material deviation from Course Syllabus
or Board Policy
Disparate treatment not covered by civil
rights policies
Please summarize the basis for this appeal and any evidence to support it (attach additional
pages if necessary).
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Student Signature _________________________________________ Date___________________________________
Decision (completed by (1) Instructor of Record, (2) Instructional Dean, or (3) CAO)
Decision regarding Final Grade Dispute:___________________________________________________________
Basis for Decision ____________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Signature ______________________________________________ Date __________________
Title____________________________________________________
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V.G. Student Final Grade Appeal Forms A-2
Form V.G.2.: Decision
of Academic Appeals Committee
Academic Appeals Committees should use this form to record their decisions according to
Section V.G. of the Policy Manual and the procedures adopted thereunder. This decision must
be signed by at least three members of the Academic Appeals Committee who attended the
hearing for this matter. The Final Grade Dispute Forms (Form V.G.1) that preceded the
hearing should be attached to this form.
Decision
Based on the evidence presented at the hearing, we find that the grade received by
___________________________________ (Student’s Name) in ________________________________ (Course
Title and Number) should be _______ retained or ______ changed for the following reasons:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
This decision represents our best judgment regarding the subject matter of the hearing.
____________________________________ ______________________________________ __________________
Printed Name Signature Date
____________________________________ ______________________________________ __________________
Printed Name Signature Date
____________________________________ ______________________________________ __________________
Printed Name Signature Date
____________________________________ ______________________________________ __________________
Printed Name Signature Date
____________________________________ ______________________________________ __________________
Printed Name Signature Date
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Student Final Grade Appeal Forms (fillable Forms) (Lone Star College System)

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Completed 6 October 2020

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