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Complaints and feedback form
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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
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?
*
Grade change on academic transcript records appeal
*
Term
Year
Course ID (ex. MTH 95)
CRN (5 digit number)
Term Final Grade
Add
Remove
Click on the plus icon to add additional courses.
What happened?
*
When did it happen?
*
Why are you appealing?
*
Are you seeking a W grade on your transcript?
*
Yes
No
Are you seeking a tuition waiver?
*
(see
Tuition Appeal Information
)
Yes
No
Which of the following is the reason for the appeal
*
Hardship
Personal illness, or injury; medical documentation required, and may include one of the following: A notice from your physician stating you are under their care; Hospitalization receipt, etc.; Note, you do not need to share the type of illness
Illness, or injury of an immediate family member; medical documentation required, and may include one of the following: A notice from your physician stating you are under their care; Hospitalization receipt, etc.; Note, you do not need to share the type of illness
Required job transfer out of the area (distance learning courses are not eligible); Verification on company letterhead required
Someone in your family has passed away; documentation is required and may include one of the following: Funeral pamphlet, Published notice of death, Certificate of Death
Military call to duty; documentation is required and may include one of the following: A copy of the Letter of Orders, How much notice did you receive for the call to duty?, How long of a notice to duty did you receive?
Other
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?
*
This field is hidden when viewing the form
Are you requesting a tuition refund/waiver?
Yes
No
Not applicable
This field is hidden when viewing the form
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
Attach relevant documents
Submitting documentation is optional. You can submit up to three documents.
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 5 MB, Max. files: 3.
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Comments
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