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Grade Appeal Form

Please fill out this form if you wish to appeal a grade.

Name

Student ID

Phone Number

Denmark Tech Email Address

Permanent Address

Local Address

Date of Incident

Time of Incident

Name of Instructor

Instructor's Academic Division

Instructor's Email Address

Instructor's Phone Number

Semester

Course Number and Section

Have you Discussed your grade with the instructor of record?

Course of Action

Please give a detailed description (to include dates and times) of your communication with the instructor. Explain the reason(s) you are appealing your grade(s) and give clear and specific information. How would you like this grievance/concern to be resolved?

Grade Appeal Form