Fillable ACADEMIC AFFAIRS WTB 321 COURSE REMEDIATION AGREEMENT FORM (University of Texas at Tyler)

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ACADEMIC AFFAIRS WTB 321 COURSE REMEDIATION AGREEMENT FORM (University of Texas at Tyler)

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ACADEMIC AFFAIRS
WTB 321
Phone: 903.566.6530
COURSE REMEDIATION AGREEMENT FORM
SECTION 1: STUDENT INFORMATION
Students requesting course reassessment or remediation, should complete SECTION 1 of this form. The request needs to be in
writing and submitted by the deadline specified in the FCOP Student Handbook.
Student Name:
Student ID:
UT Tyler Email:
@patriots.uttyler.edu
Session/Year
Course Name/Number:
Course Coordinator:
Faculty Advisor:
A. C
lass of 2020 Students ONLY:
☐ I am requesting Reassessment ONLY.
☐ I understand that by engaging in course reassessment, I am waiving my right to appeal the original final course grade.
PLEASE NOW SKIP TO PART C BELOW.
B. AL
L STUDENTS REQUESTING REMEDIATION
SHOULD COMPLETE THE FOLLOWING INFORMATION
To qualify for remediation students cannot be on academic probation. Students who remediate must have demonstrated
regular attendance and fulfilled the terms of all academic alerts and academic watches. It is the sole responsibility of the
student to demonstrate participation in these activities to the FCOP Associate Dean of Academic Affairs to qualify for
course remediation.
I h
ave attended all the class dates for this course, except (specify and include reason for non-attendance):
I h
ave met with the following people/offices to discuss my progress and/or discuss making improvements in this course:
☐ My
Faculty Advisor (dates):
☐ The Course Coordinator and/or Course Instructors:
Name/Date:
Name/Date:
Name/Date:
☐ Review Sessions (dates):
☐ Peer Tutoring (tutor name/dates):
☐ Other:
C. Student Signature: Date:
SEC
TION 2: ELIGIBILITY VERIFICATION
The Office of Academic Affairs will determine if the student is eligible for reassessment and/or remediation.
☐ The student is eligibility requirements for ☐REASSESSMENT or ☐REMEDIATION
☐ The student is not
eligible for ☐REASSESSMENT or ☐REMEDIATION. Brief explanation:
Associate Dean of Academic Affairs:
Date:
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Ben and Maytee Fisch College of Pharmacy
The University of Texas at Tyler
3900 University Boulevard • Tyler, TX 75799 • (903) 566-7168
SECTION 3: REMEDIATION / REASSESSMENT CONDITIONS
The Course Coordinator will determine the date and time of the assessment. Deadlines to complete the
assessments are provided in the FCOP Student Handbook.
The student will be assessed via: ☐ Written Exam, ☐ Oral Exam, ☐ Skills Assessment
The reassessment will take place on: _____________________ (date) from __________(start) to __________ (end).
Course Coordinator:
Date:
SECTION 3: STUDENT AGREEMENT
The student will indicate their acceptance of remediation or reassessment conditions and return to the Course Coordinator.
☐ By signing below, I am indicating that I understand and will adhere to the terms in this agreement
Student Signature:
Date:
Copies of the completed form should be sent to: Student, Office of Academic Affairs, Course Coordinator, and Faculty Advisor
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ACADEMIC AFFAIRS WTB 321 COURSE REMEDIATION AGREEMENT FORM (University of Texas at Tyler)

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Completed 24 July 2020

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