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Grade Change Form
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GRADE CHANGE
Name: _______________________________ Student # _____________ Semester: ____________ Year: ___________ Credit Hours: ________ Course ID: ___________ Course Title: __________________________ Change ____________ to _____________ Reason: _____________________________________________________
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_____________________________________________________ Instructor’s Name (p lease pr int ) : ___________________________________ Instructor’s Signature: ________________________ Date: __________ VP for Academic Affairs: ________________________ Date: _________
OFFICE USE ONLY
Date entered in computer
____________/_____________/_____________
