Grade Change Forms: IKAC-R

(This form is to be completed by the student requesting a grade change and submitted to the student’s classroom teacher. The teacher will complete his or her portion and then submit to the building principal for determination)

School: ___________________________ Date Request Received: _____________

Student: ___________________________ Class _______________Grade_________

Teacher: __________________________

Student’s Reason for Requesting the Grade Change: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Teacher Response to Request for Grade Change: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Student’s Grades in the Class: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Teacher’s Signature: ______________________________ Date of Response: ________

Principal’s Response: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Principal’s Signature: _____________________________ Date of Response: ________

 

(This form is to be used for either a student appeal or a teacher appeal, or when the requested grade change is outside of the 30-day limit for such requests. This form is to be used in conjunction with Part One.)

School: ________________________ Date Review Received: ______________

Student: ________________________ Class ____________ Grade ___________

Request Reviewed by: ___________________________________________________

Reviewer’s Response to Request: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Final Determination: Original Grade _______________ New Grade _____________

Reviewer’s Signature: ___________________________ Date: __________________

(Written notice will be provided by the building principal to the student and parents/guardians. In addition, the principal will ensure that a copy in placed in the student’s permanent file. Finally, the principal, if appropriate, will instruct the registrar to change the electronic grade, and to update all files and transcripts.)