Grade Change Request Form

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GRADE CHANGE
REQUEST FORM
’
TH
, 60 P
P
, 20
F
, N
, NJ 07102
RETURN TO THE REGISTRAR
S OFFICE
ARK
LACE
LOOR
EWARK
OR
F
973-242-3282
AX TO
Student Name
Student ID:
Course Code
Course Title & Instructor
Credits
Reason for requesting grade change:
Instructor
Change Grade:
Original Grade
Adjusted Grade
S
A
TUDENT
FFIRMATION
I have read the petition from thoroughly and understand all the requirements stated herein:
Student’s Signature: ___________________________________________________________
Date: _________________
ADMINISTRATIVE ACTION
Approved
Denied
Instructor:
Date:
Approved
Denied
Department Chair or Dean:
Date:
Received:
Registrar:
Date Posted:
Comments:
Version: 12/15/2014

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