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.