Revised: 6/19/2019
All previously dated material is now invalid.
GRADE CHANGE FORM
Please type or print.
STUDENT’S LEGAL NAME____________________________________________________________________
Last First Middle
TODAY’S DATE_________________________ STUDENT’S COCC ID NUMBER ________________________
NAME OF HIGH SCHOOL_____________________________ TEACHER_____________________________
COCC
Course
Number
COCC Course Title
COCC
CRN
COCC
Term and Year
Credits
Previous
Grade
New Grade
REASON FOR CHANGE:
REMOVAL OF INCOMPLETE
OMITTED GRADE
JUSTIFICATION/EXPLANATION________________________________________________________________
__________________________________________________________________________________________
CHANGE OF GRADE
JUSTIFICATION/EXPLANATION________________________________________________________________
__________________________________________________________________________________________
INSTRUCTOR’S SIGNATURE
MUST BE SIGNED BY INSTRUCTOR WHO ISSUED ORIGINAL GRADE
COCC MENTOR’S SIGNATURE
Mail, fax, or e-mail completed form to:
College Now Office collegenow@cocc.edu
Central Oregon Community College 541-504-2930 (phone)
2600 NW College Way 541-317-3071 (fax)
Bend, OR 97703
For COCC Office Use Only:
Date Received: __________________
Entered permanent record: _______________________________________________
INITIALS DATE
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