SIMMONS UNIVERSITY
Office of the Registrar
300 The Fenway, Boston, MA 02115
Tel 617.521.2111 Fax 617.521.3144
PASS/FAIL FORM
Please print the following information:
Student Name: ____________________________________________________
Simmons ID #: _______________________ Class Year: _______________
Undergraduate students may select one course for the pass/fail grading option each
semester.
Courses taken to fulfill certain competency requirements may not be taken for the pass/fail
option (i.e. the Boston Course, any course counting toward the Language Requirement,
MATH 101, MATH 102, Independent Learning, The Capstone). In addition, certain majors
and minors require that courses be taken for a letter grade. Decisions regarding pass/fail
should be discussed with your academic adviser.
As with all transactions, you should retain a copy of this form for your records
. The form is
valid only when
dated and initialed
by a member of the Registrar’s Office staff.
COURSE DESIGNATED FOR PASS/FAIL:
Course Dept: ______________Course No: ____________ Section: ___________
Instructor Name: ____________________________________________________
Please note that pass/fail does not affect your GPA when the grade is a Pass. A failing grade
will affect your GPA.
Student’s Signature: _______________________________________ Date: _________
Instructor’s Signature: _____________________________________ Date: _________
Adviser’s Signature: _______________________________________ Date: _________
Registrar’s Staff: __________________________________________ Date: _________
If taking for Major or Minor:
Department Chair: __________________________________________ Date: _________
RETAIN THE LAST COPY FOR YOUR RECORDS AFTER THE FORM IS
PROCESSED IN THE REGISTRAR’S OFFICE.
click to sign
signature
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click to sign
signature
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click to sign
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