GRADE CHANGE APPLICATION
SCHOOL YEAR 2020–2021
Instructions:
Parents of students shall complete the form below to request a grade change for the
202021 school year. Fill in all fields, sign the form, and submit to your child’s local
educational agency.
Student Information:
First Name: Last Name:
Student ID: Student Grade: 9 10 11 12
School Information:
School Name:
Semester: Fall Spring Summer
Term (Block Schedule): Term 1 Term 2 Summer
Courses to be changed:
Course
Code
Course Title Teacher Name
Current
Grade
Grade Change
P/NP
Education Code:
Pursuant to Education Code Section 29066.5 (2)(b): The parent, guardian, or education
rights holder of a pupil or, for a pupil 18 years of age or older, the pupil who was
enrolled in high school and enrolled in a course during the 2020–21 school year may
apply to the pupil’s local educational agency to have a letter grade earned for that
course, as reflected on the pupil’s transcript, changed to a Pass or No Pass grade.
Parent/Guardian/Education Rights Holder Signature:
Today's Date
California Department of Education, July 2021
click to sign
signature
click to edit