Grade Appeal Form

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Student Acknowledgements

You, the student, acknowledge that:(Required)

1. You have read grade appeals policy LR 501.6.

2. From reading LR 501.6, you understand:

How long students have to file an appeal
Which grades can be appealed
What steps to take beyond the ones listed below

3. You understand that the first steps in the grade appeal process are the following:

First, I meet with my instructor to talk about my final grade.
If the issue is not resolved, I can ask the department chair to set up a meeting. This meeting will include me, my instructor, and the chair to try again to resolve the issue.
If I am unable to set up the meeting with my instructor or the chair because of something outside of my control, I can call the Provost’s Office at (501) 916-3204 for help.

I have read the above statements and understand them.

Student and Course Information

Student Name(Required)

First Last

Student Workday ID(Required)

Student UA Little Rock Email(Required)

Phone(Required)

Instructor Name(Required)

Instructor Email(Required)

Course Title (e.g., Principles of Marketing)(Required)

Course Number (e.g., PSYC 20043)(Required)

Section Number (e.g., 01, 999, 9U1)(Required)

Semester and Year Course was Taken (e.g., Spring 2026)(Required)

Final Grade Earned(Required)

Basis for Appeal Per UA Little Rock Policy 501.6

The Basis of My Appeal is that the Instructor:(Required)

Applied the syllabus in a manner that was unfair to me (e.g., someone was given an extension but I was denied the same)

Substantially deviated from the course syllabus

Please use the section below to provide details that support your claim. Your statement should make it clear why you believe you earned a grade different from the one assigned to you in the course.

NOTE: You must attach a course syllabus to this application for the form to be submitted. It must be in PDF format.

Appeal Details(Required)

Attach Course Syllabus (PDF Only)(Required)

Accepted file types: pdf, Max. file size: 24 MB.

Waiver for Release of Academic Records

Please check the records to be released(Required)

My grades listed in the gradebook from the above course

My UA Little Rock transcripts

My tests, quizzes, papers, and other assignments from the above course

Other (Specify)

Other records to be released(Required)

Type Your Name for Consent(Required)

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