Office of the Registrar
REQUEST FOR PASS – FAIL GRADE
NOTE TO STUDENT
Pass/Fail Options: Students have the option of requesting a final grade of “Pass” or “Fail” instead of a letter grade in an elective course, in a
general studies course (but NOT in an ACR course), or in an academic minor program course. The Pass/Fail option is limited to a total of
NINE semester hours within the student’s total degree program. No more than ONE course per semester may be selected under this option.
During the regular semesters, this application must be filed with the Registrar by November 1
for Fall and April 1
During summer session, the deadline for filing is determined by the calendar for the specific summer session. See summer
calendar for dates.
STUDENT COMPLETES THIS SECTION:
Current Semester and Y
Student Email (Required)
Rev 9/2016 lcr
(PRINT) LAST NAME FIRST NAME STUDENT ID NUMBER
REGISTRAR’S OFFICE USE ONLY:
Registrar’s Staff Initials
1. Use Adobe Acrobat Reader DC to complete this form. If
needed, this can be downloaded from Adobe.com for Free.
2. All fields with a red box are required.
3. Once form is completed, click on the SUBMIT button and
the request will be emailed to email@example.com. If errors
are encountered, save the PDF form and either email
firstname.lastname@example.org or fax: 201-200-2062.
Student Signature Date
Type your name as your signature on the line above.)