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PLEASE READ AND NOTE: Students and TDLI are encouraged to read fully all the instructions and grading procedures on their course instruction syllabus and course study guides that will be sent to them. Failure to read and follow instructions noted on-in your course syllabus is one of the main reasons for a student being asked to redo course work, as is components not completed, or completely missed altogether. That being said we have placed this form here so you may have the chance to state your claim to your Student Services Coordinator.

Student Full Name:


Student ID:

Student Contact Information:

Student Address:


Please Note: Student Grades are stated how they are marked on the course syllabus, the final grade is given as a PASS FAIL or RED0 (and you will have 2 chances to redo and resubmit any paper or final grade given as REDO. _____

Course Title: _______________________________________
Please State Your Specific Request:


I certify that I have read, understand, and agree with all the information as stated above, and in the documents sent to me in my course syllabus, and course study guides, I understand that by joining as a student I agreed to submit to and follow all of the TDLI formal policies and directions as given to me in writing, in this manual, my course syllabus, and my course work study guide, and follow all of the instructions of my Student Services Officer. I understand that these policies are in place to streamline the learning policies and enhance the enjoyment of the learning process, and allow for each student to have had the same high standards to follow without exception.
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Student Signature:


Opinion of Student Services Officer: Course of Action: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Presidents Signature: ___________________________________________________

Student Services Officer Signature:



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