Fillable Request For Grade Change Form printable pdf download

Request for Grade Change

University of California, Davis

Office of the University Registrar

One Shields Avenue, Davis, CA 95616-8692 / Information: (530) 752-3639 / Fax: (530) 752-6906

This form must be completed by the instructor of the course in question and then sent to the Office of the University Registrar after

the appropriate signatures have been obtained. Provide the student's full name, student ID number, and the course's subject, number,

and CRN, and a detailed explaination of the grade change. A form without this information will be returned to the department.

Note: Academic Senate Regulation Article 3. Grades 780 (B) states: No change of grade may be made on the basis of reassessment of the

quality of a student's work. No term grade except Incomplete may be revised by re-examination. The Guidelines of the Academic Sen-

ate Committee on Grade Changes may be found at

Make a copy of this petition for your records. This petition is not to be used for removal of Incomplete or NG grades.

Personal Information

Student ID Number ______________________________________________ E-mail Address _______________________________

Name _______________________________________________________________________________________________________

Address _____________________________________________________________________________________________________

City/State/Zip ___________________________________________________ Phone ______________________________________

Course Information

CRN ___________________________________________________________ Quarter and Year ______________________________

Course Subject __________________________________________________ Course Number_______________________________

Section _________________________________________________________

New Grade _____________________________________________________ Original Grade _______________________________

Reason for request

Provide detailed basis for this request. Attach additional pages, as necessary.

Required Signatures

Instructor (print) ___________________________________________________

Instructor signature _________________________________________________ Date ________________________________________

Department Chair (print) ____________________________________________

Department Chair signature __________________________________________ Date ________________________________________

Department Use Only

Final action

Approved

Denied

Comments ________________________________________________________________________________________________

__________________________________________________________________________________________________________

Posted ________________________________________________

RO Grade Change Petition

OUR-D047

This revision supercedes all earlier revisions.

rev. 8/11

Request For Grade Change Form