Student Hand Book 2021-2022

GRADE APPEAL FORM
Student Name:
ID:
Address:
City: State: Zip:
WUSOM Email:
Cell Phone:
Present semester Anticipated Graduation I appeal
the course grade of taken in (semester)
Department:
Course Instructor:
Department Chair:
I believe I earned a grade of
The basis for this appeal:
Evidence attached: YES/NO
Informal conference with instructor was held on
Department Chair
(date)
(date) Submitted to
I am requesting an appeal for a course grade. I understand that consideration of my request is contingent upon
the attached supporting documentation.
Student Signature
Date
An electronic signature is sufficient if received from a WUSOM email address
Page | 99