Year: Semester: Fall Winter Spring Summer I II III
Registration / Records Office
Pass/Fail or Audit Request
SID: Date:
Last Name: First Name:
Check one: O Pass / Fail O Audit Course Number:
(Ex. ENG 101 001)
I understand that I do NOT have the option of requesting a different a grade for this course in the
future. I also understand that I will pay full tuition and fees. I have read the College Catalog section that
describes Audit and Pass/Fail grade.
Student Signature: Date:
tructor Signature: Date:
cial Aid Signature*: Date:
e: If you are receiving any form of financial aid (including TAP or a student loan) the signature of a financial
aid counselor is required. Your financial aid could be adversely impacted by this change.
Records Office Use Only
Processed by: Date: