1. STUDENT INFORMATION

Student First Name

Student Last Name

Student NetID

Department - Course Number - Section (Example: SOC 100 - 01)

Course Title

Units

Term

Fall

Spring

Summer

Winter

Year

2. GRADE NOTE : THIS FORM MAY NOT BE USED TO CHANGE A GRADE TO W (Withdrawal)

Original Grade Assigned

Grade to be Changed To

If the original grade was "Incomplete (I)" or "Satisfactory Progress (SP)/Report In Progress (RP)", give date that all coursework was completed and if one semester extension is also approved. See current catalog for policy on "Incomplete" and "Satisfactory Progress/Report in Progress" grades."

Date Completed

Check box if they need one semester extension

3. REQUIRED SIGNATURES

Name of Instructor

Date

Email of Instructor

Name of Department Chair

Email Of Department Chair

Email Of CC person (Only one email address is accepted)

For changing Incomplete or SP/RP to letter grade, Registrar must approve. Verify that the grade has not reverted to “F” or “IC”. If the grade has reverted, College Dean must sign.

College dean must sign and approve or deny if change of grade is other than Incomplete or SP/RP to letter grade.

Name of Associate Dean or Dean

Email of Associate Dean or Dean

4. INDICATE THE REASON FOR SUBMITTING THE GRADE CHANGE

Changing Incomplete to Earned Grade (I to Letter Grade or CR/NC)Changing IC to Letter Grade (Extension approved after I has reverted IC)Grade not submitted by due date (RD or RP/SP to Letter Grade or CR/NC)Instructor Error/Error in recording or computing gradeOther

ContactID