Grade Appeal Request Form (Updated: May 17, 2000)

Date:	Student ID Number:
Name:
Street Address:
City:		Zip Code:
Home Phone:		Work Phone:
Email:		Cell Phone/Pager:
Course Title:		Course Number:
Semester/Year:		Professor:
Grade Received:

Before requesting a review of your grade by an academic department, you must discuss your appeal with your professor.

Have you talked with your professor concerning this grade appeal?

____Yes ____No Date of Conference:_____________________________________

Please describe in detail the basis of your grade appeal and the remedy you are seeking:

A decision on your grade appeal will be mailed to you in approximately two weeks. If you have any questions, please contact the Department of Social Sciences at 713-221-8014.