Change of Grade Form
Student Name: Tech ID: R_____________
Last First MI
Term Originally Registered Original Grade
Course Title
Course CRN ____________ Course Prefix, Number, & Section
Date of New Grade New Grade
Justification
ALL ELECTRONIC SIGNATURES ARE REQUIRED FOR THIS CHANGE TO BE VALID
Instructor/Program Director ___________________________________________Date_________
Associate Dean/School Designee _______________________________________Date_________
Registrar Staff Date_________
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