Grade Change Authorization Form
A. Current date
B. Department and school
C. Student's full name
D. Student’s Social Security number
E. Name of the program in which the student is currently enrolled
F. Student’s 10-digit university ID number
G. Subject of the course in which the grade change will take place i.e. ENG
H. Catalogue number of the course in which the grade change will take place
I. Class number of the course in which the grade change will take place
J. Number of credit hours of the course in which the grade change will take place
K. Title of the course in which the grade change will take place
L. Semester and year in which the student took the course
M. Grade received by the student in the course
N. Grade the student’s previous grade will be changed to
O. Reason for the student’s grade change
P. Signature and date of the instructor for the course in which the grade change will take place
Q. Signature and date of course instructor’s representative (needed only if instructor cannot sign)
R. Signature and date of the dean of the program in which the course is offered
S. Signature and date of the dean’s representative (needed only if dean cannot sign)
T. Signature and date of the campus registrar
