Grievance

APPEALS FORM FOR ACADEMIC GRIEVANCES For All Students –– All Campuses

After reviewing the section on grievance policy and student complaints in the student handbook please complete

this form and submit it along with any supporting documentation to the Registrar’s office electronically, by

emailing it to [email protected]. The decision of the Appeals Committee is final and may not be

changed.

Please be sure to submit all documentation at one time. The Committee will not process incomplete applications or

those submitted without necessary documentation. This is an official academic committee and your submission

should reflect respect for the committee members by submitting a grammatically correct appeal, which explains

what caused the initial issue to occur and your strategy for ensuring you are able to succeed academically if the

appeal is granted.

Please allow at least two weeks for the committee to render a decision in regards to your appeal. You will be

notified in writing of the Committee’s decision via their official student email account.

PLEASE TYPE

1. Student Information

Name________________________________ Social Security #___________________ Belhaven ID #_________

Campus Address__________________________________________Campus Phone_______________________

Home Address: Street_______________________________________ City___________ State___ Zip________

Home Phone __________________ Other Phone_________________E-mail Address______________________

2. Steps in the Appeal Process

Before you submit an appeal to the Academic Appeals Committee, you must consult first with those

involved in an effort to solve the problem. To show you have gone through the appropriate steps in trying

to resolve the problem, signatures are required from the proper university official, signifying they have

discussed the problem with you and have been unable to resolve it. If the university official agrees with

your appeal and finds a resolution to the problem, the process ends there.

Signature:__________________________________________________ (university official- An approval

email from the university official may suffice for a written signature)

3. Statement of the Problem

In the space below, describe as clearly as possible the decision/policy that you wish to appeal:

4. Support for Your Academic Appeal

State below the reasons why the Academic Appeals Committee should grant your appeal. This should include what

circumstances led to the poor academic performance, which led to suspension, dismissal, or failing a course two

times and needing to retake it a third time.

6. Strategy for Success in the future

Please state what your strategy will be to ensure academic success should your appeal be granted. These should be

actual steps that you are committed to implementing, which should directly lead to improved academic

performance. Personal faith or spiritual actions, which may be valid and encouraged, will not be considered an

adequate strategy in and of themselves.

7. Supporting Documents

List below the supporting documents that you are submitting with your academic appeal. You should provide

official evidence to document your claims.

GRIEVANCES ON ACADEMIC ISSUES AND GRIEVANCES CONCERNING A FACULTY MEMBER:

You may submit this form to the Registrar who will serve as Appeals Coordinator and will direct the appeal

to the proper committee or university official.

Academic grievances concerning a faculty member will be directed to the faculty’s department chairperson.

In cases where the faculty member also holds the chair of the department, grievances will be directed to the

division chairperson. In the case of division chairpersons, grievances will be reported to the Provost.

8. Student’s Signature

Submission of this form to [email protected] from a valid student account

(*@students.belhaven.edu) will serve as your official electronic signature.

Procedure for Reporting Grievances:

1. All student grievances must be submitted in writing to the Registrar who will serve as the Appeals

Coordinator.

2. The Registrar will review the grievance and submit the written complaint with all documentation to the

Academic Appeals Committee.

3. When the Committee or university official takes action, the student will be notified in writing of the

decision via their official Belhaven Student Email account.

4. Decisions made by the Academic Appeals Committee are final and may not be changed.