CHANGE OF GRADE FORM
DATE: _________________
LOCATION (Check one): Belle Glade Boca Raton Lake Worth Palm Beach Gardens
TERM/YEAR (Of Course for Grade change) FALL SPRING SUMMER Year _____
STUDENT’S NAME: ______________________________________________________________
STUDENT ID: __________________________
COURSE
REF. # ______ COURSE ID _______ TITLE _______________________________________
INSTRUCTOR’S NAME _____________________________________________________________
REASON FOR GRADE CHANGE _____________________________________________________
___________________________________________________________________________________
STUDENT’S LAST DATE
CURRENT GRADE _____ NEW GRADE ______ OF ATTENDANCE ______________
(Required if assigning FX or UX grade)
__________________________________________________ ____________________________________________________
INSTRUCTOR'S SIGNATURE ASSOCIATE or ACADEMIC DEAN SIGNATURE
ALL GRADE CHANGE FORMS MUST BE SIGNED BY THE ASSOCIATE DEAN or ACADEMIC DEAN.
THIS FORM IS VOID IF DELIVERED BY THE STUDENT.
* * * Submit original form to your Campus Registrar’s Office. Please retain copies for your records. * * *
