Last Name First Name Middle Initial
Student ID Number
PETITION FOR GRADE CHANGE - REPORT OF MAKE-UP OF INCOMPLETE
A grade of Incomplete will not be changed after a degree or credential has been awarded. See the bulletin for details. An Incomplete
must be completed within one calendar year immediately following the end of the term in which it was assigned. If there are
extenuating circumstances and the one year limit has not passed, the student may request an extension of the one-year limit through a
Petition for Waiver of College Regulations. Petitions must be delivered to the Registrar's Office at One Stop Student Services
Center, SSB 101 by staff members only. Petitions will not be accepted by students.
REPORT OF MAKE-UP OF INCOMPLETE
PETITION FOR GRADE CHANGE
Requires action by Instructor and Department Chair.
Requires action by Instructor and Department Chair. Most grade
changes can be done on Web Grades. Note: If request includes
grading option change please use Waiver of College
Regulations petition instead of this form.
Dept. & Course #: Class Number:
Term/Year course taken:
Units: Course Title:
Address: City: State: Zip Code:
Phone Number: E-mail:
Student's reason for requesting a grade change:
ACTION BY INSTRUCTOR:
New Grade
Plus
Minus
Neither
Previous Grade: Date work submitted to instructor:
Approved Denied
Reason Approved or Denied:
Instructor Name: Instructor Signature: Date:
ACTION BY DEPARTMENT CHAIR:
Approved Denied
Reason Approved or Denied:
Dept. Chair Name: Dept. Chair Signature: Date:
Registrar's Office Use Only
New Grade Previous Grade Date Recorded MMDDYY
IF GRADE CHANGE REQUEST ALSO INCLUDES A GRADING OPTION CHANGE
PLEASE REFER TO THE
WAIVER OF COLLEGE REGULATIONS PETITION
