STUDENT GRIEVANCE APPLICATION
Please provide the information requested below. Submit the completed application along with all
supporting documentation to the Dean’s Office in the Howard Jordan Building, Room 108.
This application is related to:
☐Grade Appeal
Grade Received:
☐Other matter
State the Issue:
Grade Expected:
OR
The applicant must provide the following:
• One copy of this completed form (must be signed and dated)
• One copy of the complaint (item 1 on the next page)
• One copy of each supporting document (item 2 on the next page)
If this is a grade appeal, applications must be submitted within seven (7) calendar days of the first day of
class of the next semester (excluding summer).
Name: _____________________________________________ Student Id#: _________
Address: _____________________________________________________________________________
Telephone: ___________________________________________________________________________
(Home)
(Mobile)
(Work, if applicable)
SSU Email (REQUIRED): _______________________________________________________________
Alternate Email:_______________________________________________________________________
*************************************************************************************
This Appeal Refers To:
Faculty Member:
Course Name
Course #
Sec.#
Term/Year
Before an official grade appeal can be filed with the Grade Appeal Committee, the student must have
followed the proper procedures mandated by the College of Business Administration:
Have you discussed the grade appeal/other issue with the professor? Yes ☐No ☐
If you answered YES please sign application and proceed to next page. If you answered NO to the
above question for the grade appeal, the Grievance Committee cannot accept the application. If
you answered NO for other issues, please sign application and proceed to next page.
Signature
Date
COMPLETING YOUR APPEAL
1. Statement of Complaint: In a separate typed letter (please do not exceed two pages) explain why
you are making this appeal. If this is a grade appeal, in your explanation you must articulate clearly
why you believe the grade you received is incorrect. You must put forth a legitimate argument and not
simply state that the grade is too low. All essential supporting documentation must be provided by you
at the time your appeal is submitted to the Dean’s Office. HANDWRITTEN APPEALS AND
APPEALS WITHOUT SUPPORTING DOCUMENTATION WILL NOT BE ACCEPTED.
2. Supporting Documentation: Before an appeal is brought to the attention of the Student Grievance
Committee, the student must provide the following information:
Grade Appeal
a. A copy of the course syllabus
b. Copies of all graded work (examinations, papers, extra credit, e-learning print outs, etc.)
c. A copy of any correspondence with the professor regarding the case, if applicable
d. A copy of any documentation for legitimately excused absences (ex: doctor’s excuse, court
summons), if applicable.
Other Issue(s)
a. A copy of the course syllabus, if applicable.
c. A copy of any correspondence with the professor regarding the case, if applicable
d. A copy of any documentation for legitimately excused absences (ex: doctor’s excuse, court
summons), if applicable.
THIS SECTION TO BE COMPLETED BY THE DEAN’S OFFICE ONLY:
Date
Received in the Dean’s Office
Faculty Informed about Complaint
Forwarded to Appeal Committee
Recommendation Received from
Appeal Committee
Recommendation forwarded to Student
Recommendation forwarded to Faculty
Member
By