Qualtrics Survey | Qualtrics Experience Management

First name:

Last name:

Laurier ID:

Laurier email:

Program:

Provide a brief explanation identifying the specific reason for the final grade reassessment:

A clean, unmarked copy of the work in question:

The original graded copy (if not a final exam):

Course outline:

The requirements for the work in question (if separate from the course outline):

Any other materials relevant to the assessment, such as communication with the course instructor:

Acknowledgement Statement:

I acknowledge that the grade reassessment process can result in being assigned a grade lower than originally assigned by the course instructor.

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