Academic Appeal Form

Academic Appeal Form — Form Fields

This education template includes 9 fields across 2 pages. Allow students to formally appeal academic decisions such as grades or dismissals. Free to customize and use on ZenBuild.

• Student Name (text, required)
• Student ID (text, required)
• Email Address (email, required)
• Course Name and Number (text, required)
• Type of Appeal (dropdown selection, required) — options: Grade change, Academic probation, Academic dismissal, Late withdrawal, Other
• Describe the Circumstances (long text, required) — Be specific and include dates, events, and any extenuating circumstances.
• Requested Resolution (long text, required)
• Supporting Documentation (file upload, optional) — Upload any supporting documents (medical notes, emails, etc.)
• Student Signature (signature, required) — I certify that the information provided is accurate and complete.