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Grades/Evaluation Of Student Achievement   

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GRADE CHANGE FORM

(Please Print)

DATE OF GRADE CHANGE REQUEST: GRADE LEVEL:

STUDENT NAME: STUDENT ID#:

GRADING PERIOD:

(Please Circle Applicable Grading Period)

ELEMENTARY SCHOOL: FIRST SECOND THIRD TRIMESTER

HIGH SCHOOL: PROGRESS REPORT: 1 2

FIRST SEMESTER

PROGRESS REPORT: 4 5

SECOND SEMESTER

COURSE: COURSE #:

REASON FOR GRADE CHANGE:

_ CLERICAL OR MECHANICAL MISTAKE

_ INCOMPLETE GRADE:

_ OTHER:

GRADE ORIGINALLY RECORDED: GRADE CHANGED TO:

(Grade) (Grade)

TEACHER NAME:

TEACHER SIGNATURE:

REGISTRAR NAME:

REGISTRAR SIGNATURE:

DATE GRADE CHANGE COMPLETED BY REGISTRAR:

* This form is to be completed in its entirety and shall be maintained by the registrar.

* Any supporting comments and/or documentation must be attached to this form.

* Grades may only be changed within six weeks of assigning the initial grade. Grades may be changed up to the next six week period that school is in session.

* Grades may only be changed by the teacher of record. In the event of a catastrophic situation prohibiting the teacher from signing the form, the form may be signed by both the principal and superintendent.

Exhibit AROMAS-SAN JUAN UNIFIED SCHOOL DISTRICT

version: January 25, 2012 San Juan Bautista, California