10/9/2013
OFFICE OF THE REGISTRAR
MSC 105, 1050 W SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-8202
PH (361) 593-2811 * FAX (361) 593-2195
www.tamuk.edu
(Please print)
Name: ___________________________________________________ ID #: __________________________
(Last) (First)
Phone #: __________________________________ Email: ______________________________________
Course Name
Course Number
Semester First
Taken
Grade
Semester
Repeated
Grade
Are you GRADUATING this semester? ____ Yes _____ No
Are you on SCHOLASTIC PROBATION or ENFORCED WITHDRAWAL? ____ Yes _____ No
Have you requested a transcript to be sent after grade change? ____ Yes _____ No
Student’s Signature: _______________________________________ Date: _________________________
******************************************************************************************
REQUEST FOR ADJUSTMENT OF REPEATED COURSES
FORM
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