Grade Change Form

Faculty First Name:(Required)

Faculty Last Name:(Required)

Faculty Email:(Required)

Semester/Year(Required)

Course Name:(Required)

CRN Code:(Required)

Course Number:(Required)

Student EMPLID:

Student Name(Required)

Student Email(Required)

Temporary Grade:(Required)

Final Grade:(Required)

Grade Change Explanation(Required)

Submission Date(Required)

Faculty Printed Signature:(Required)

Faculty Signature(Required)

Under penalty of perjury, I herewith affirm that my electronic signature, and all future electronic signatures, were signed by myself with full knowledge and consent and am legally bound to these terms and conditions.

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Grade Change Form