Revised12/2009
Grade Correction Form
1. Instructor/Faculty
Please change the grade for __________________________________________CWI#__________________
First Name Last Name
In the class ___________ ____________ ________ _________________________________________
PREFIX COURSE NO. SECTION TITLE OF COURSE
Taken in the: Jan Mini Session Spring Summer Aug Mini Session Fall
of ________ from a grade of _________ to a grade of __________.
YEAR
My reason for changing this grade is: __________________________________________________
__________________________________________________________________.
________________________________________ ______________________
INSTRUCTOR’S SIGNATURE DATE
Please forward this form to your division chairperson for signature.
2. Division Chair
Approved, forward to Vice President for Academic Services
Disapproved. Return to instructor
________________________________________ _______________________
DIVISION CHAIRPERSON’S SIGNATURE DATE
Please forward this form to the Vice President for Academic Services
3. Vice President for Academic Services
Approved, forward to Registrar
Disapproved. Return to Instructor
________________________________________ ________________________
VICE PRESIDENT FOR ACADEMIC SERVICES SIGNATURE DATE
4. Registrar
The above grade change has been made on the transcript and all permanent records of the aforementioned student.
________________________________________ _________________________
REGISTRAR’S SIGNATURE DATE
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