Shippensburg University
Undergraduate Grade Appeal Form
Grade Appeal form is not Valid Unless Completed in Full and Filed in a Timely Fashion
I. Student Information:
Student Name:_______________________________ Student ID No.: ___________________
College of Student’s Major: ____________________ Major: ________________________
Class Standing (Check One) Freshman ___ Sophomore ____ Junior ___ Senior ____
Last Day to File a Grade Appeal: __________ Today’s Date: _______________
Postal Address(es) to which all university communication concerning this appeal will be directed:
______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
E-mail Address(es): _______________________________________________________________
Phone #(s): ______________________________________________________________________
II. Course for Which Appeal in Being Filed:
I Hereby Register a Formal Grade Appeal Against: _____________________ (name of the instructor)
in Course Name: ____________________________, Course Number _______, Section: ____, taken
during the ______Semester 20___.
III. Basis for the Appeal (Check Appropriate Line(s)):
____The Course Instructor Miscalculated the Final Course Grade.
___ The Course Instructor Committed an Oversight in Calculating the Final Course Grade.
___ The Course Instructor acted in an “Arbitrary and/or Capricious” Manner in Assigning Grades, including
the Final Course grade to the Student.
___ The Course Instructor in Assigning grades discriminated against the student on the basis of race, color,
religion, creed, lifestyle, sexual orientation, ancestry, national origin, age, union membership, sex,
disability or Veteran’s status.
IV. Desired Resolution
Grade Given by the Instructor______ Grade Expected by Student ________
Student Signature:______________________________________
Attach to this form a written statement detailing the basis for your grade appeal and the justification
for the grade change desired.
Received By ____________ Name of Department ____________
(Departmental Representative)
Date ___________ Time _________
Cc: Dean’s Office
