Feedback form

Complaints and feedback

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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*

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

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

Are you seeking a tuition waiver?*

(see Tuition Appeal Information)

Yes

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?*

Hidden

Are you requesting a tuition refund/waiver?

Yes

Not applicable

Hidden

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

Yes

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

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 5 MB, Max. files: 3.

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Phone

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