Regents Online Degree Programs - Grade Change Form

Instructors: Please complete this form, print, and send to your institutional RODP Campus Contact.
Instructor Information  
Last Name:   First Name:
Email:   Phone #:  
Department Chair Email:   Phone #:  
Department Dean Email:   Phone #:  
Student Information  
Last Name:   First Name:    M.I.:  
Student ID:    
Subject Area:   Course #:  
Semester: Year:
Change grade from:    to: Hrs Credit:
Date Student Completed Course Work to Remove I Grade (if applicable): Day: Month: Year:
Reason for Grade Change:  
Computational Error  
Grade transposition.
Instructor missed deadline for turning in 'incomplete' grade form to the Office of Records.
Student missed final exam due to personal or immediate family physical illness or accident.
Instructor failed to consider all work (paper, project, etc.) or failed to average in all tests.
Request to change a previously assigned grade to a 'W' (documentation of extenuating circumstances must be attached).
Incorrect grade assignment because of name change or student ID number change.
Other (Explain in 'Comments' section).
 Comments:

                   

 
Follow grade change procedures at your institution for signatures. MUST BE ORIGINAL SIGNATURE--no ink stamps.
 
 Instructor's Name (print or type) _______________________________________________
 Instructor's Signature _________________________________________ Date __________
 Dept Chair's / Dean's Name (print or type) _______________________________________
 Signature of Dept Chair or Dean ________________________________ Date __________
 Campus Contact Signature at Instructor's Institution _______________________________
 Campus Contact Signature at Receiving Institution ________________________________
 Date processed in Registrar's Office: __________  Processed by: __________