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Feedback form
Select the option that most applies to your feedback
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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:
Personal well-being, safety, discrimination, or harassment
Grade change on academic records appeal
Tuition appeal
Community education tuition waiver/refund appeal
Name
*
First
Last
Email
*
Must be a @pcc.edu email address
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:
Explain why you believe you were graded improperly.
*
What were the alleged discrepancies in points, and/or grades?
*
What have you done in order to resolve the grade dispute first?
*
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
Select files
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 20 MB.
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