Academic and Course Grade Appeals Form

Choose One	*
Student Name	*
Student Number	*
Email	*
Phone	*
I. Appeal of Final Course Grade
Semester of class enrollment
Year
Course Number
Section
Course Title
Instructor
Original Grade Received
Explanation of grade appeal
II. Academic Appeal
Date of incident occurrence
Person(s) against whom this appeal is directed
Statement of facts related to this appeal, include all main points and detailed information
Provide a summary of the desired outcomes you wish as a result of this appeal

Ozarks Technical Community College