Instructional Complaint/Grade Grievance Form
The dean will discuss the complaint or grade grievance with the student within 10 (ten) working days of submission of this form. He/she may request a combined or individual meeting with parties involved. Within 10 (ten) working days of that discussion, a written response will be provided to the student and all parties involved. The time for response may be extended by mutual agreement.
Name
First Name
Last Name
Date
Phone Number
Email
example@example.com
Please attach any relevant documentation.
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Instructor of concern:
Student concern(s)
Recommended resolution (if applicable)
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I have communicated my concern with my instructor and made an effort to find a resolution before submitting this form.
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