Feedback form

Select the option that most applies to your feedback*

General Complaint
General Concern
Course and/or complaint about instruction
Term final grade dispute appeal
Suggestion
Compliment

These types of appeals have a different process - this form is not the correct step to take for these appeals:

Name*

First Last

Email*

PCC ID number*

Phone

Address

Street Address City State Zip code

Course and/or complaint about instruction*

Term

Year

Course ID (ex. MTH 95)

CRN (5 digit number)

Instructor’s Name

Term final grade dispute appeal*

Term

Year

Course ID (ex. MTH 95)

CRN (5 digit number)

Instructor’s name

Term final grade

Grade request

Answer the following questions. Your answers must justify your appeal for a grade change:

What have you done in order to resolve the grade dispute first?*

Explain why you believe you were graded improperly.*

What were the alleged discrepancies in points, and/or grades?*

What is your complaint?*

What is your concern?*

What is your suggestion?*

What is your compliment?*

When and where did this happen?

Include date and time if applicable.

How have you attempted to resolve this issue?

What outcome or resolution are you seeking?*

Are you requesting a tuition refund/waiver?*

Yes
No
Not applicable

If you already withdrew from the course, are you requesting the term final grade be removed from your transcript?*

Yes
No
Not applicable

Additional comments

Attach the following documents below:

Course Syllabus
Email correspondences with your instructors that pertain to your attempt to resolve the grade concern
If possible include homework assignments, tests, and other materials that support your argument, etc.
Any other documents that support your dispute

Please attach any relevant documents

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 20 MB.

Portland Community College | Portland, Oregon

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