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GRADE CHANGE Name: _______________________________ Student # _____________ Semester: ____________ Year: ___________ Credit Hours: ________

Course ID: ___________ Course Title: __________________________

Change ____________ to

_____________

Reason: _____________________________________________________ _____________________________________________________ _____________________________________________________

Instructor’s Name

(please print):

___________________________________

Instructor’s Signature: ________________________ Date: __________ VP for Academic Affairs: ________________________ Date: _________

O FFI CE U SE O N LY Date en tered i n c omputer

____________/_____________/_____________


Grade Change Form