IUPUC Change of Grade Petition
In order to petition for a change in a grade received at IUPUC, you must complete this form. We ask that you type your information on the form and then print it. Grade change requests are subject to restrictions established by the faculty.

1. Name

2. Student ID Number

3. Name (if different while at IUPUC)

4. Date

5. Current Address   Street

CityState Zip

6. Daytime Phone - -        Evening Phone - -

7. E-mail

8. List the courses in which you are petitioning for a grade change

Subject-Ltr Course No.
(e.g. Eng-W131)

Full Course Title

Semester/Year Taken

9. Are you presently enrolled at an Indiana University Campus?

If yes,which campus?  What is your major?

If no, skip to item 12.

10. If you are presently an IU Student, have you already used the grade replacement (FX) option?

Yes No
Check here if your school does not honor FXs
Check here if you have changed your major, don't need these courses, or would rather not retake them
11. Is this your first semester back after a break of one or more semesters?
  Yes No
Many schools at IUPUC will not take action on a request to change grades until you have established a track record of progress (12 to 20 credits of a C or better). Skip to Item 15.

12. Are you currently enrolled in a college or university other than in the IU system?

  Yes No

If yes, please name the college you are attending:

What degree are you working on at this college?

What is your major?

Please attach a current transcript if you are enrolled at a non-IU school. If you are trying to be admitted to a college or university and are not admissible because of your prior record, please include a letter from the college regarding this matter.

Please answer the following items.
13. If you are not presently attending a college, what are your future educational plans?

14. If you are not planning to return to college, but your grades are affecting other aspects of your life, please explain in detail.

15. (A) Please explain why you received the grades you wish changed. Be sure to indicate whether you completed all of the course requirements including the final examination. The documentation is critical.

15. (B) Indicate whether you want the grade of F or D changed to a W (withdrawal) or if you want a grade changed to a specific letter grade (such as A, B, C, or D). If you want a grade changed to a specific letter grade, you must provide an explanation for the change and include a syllabus, classwork and test results. If the instructor is still at IUPUC, you should discuss the matter with the instructor prior to filing this petition. If you are concerned about privacy regarding the causes of poor grades, be assured that the university regards this petition as confidential. Only persons with a need to know will see any confidential materials, such as medical records, which you may submit. If you are still concerned, you may indicate a phone number and a time at which you may be reached to discuss this issue. If you don't recall the name of your instructor, you may call the school or division by which the course was offered.

16. If you have transferred to another institution, please explain why the change of grade is critical. Since most schools don't count grades from other colleges in your grade point average, and don't transfer in courses with grades of D or F, be sure to explain the specific impact on your academic future of the grades that you wish changed.

If you wish to add additional information, it must be in typed format and attached to this document.


Student Signature

Please return the completed form to:
Office of the Registrar
4601 Central Ave., RM 156
Columbus, IN 47203

Fax: (812) 348-7257
Phone: (812) 348-7287

The Office of the Registrar will forward your petition to the IUPUC school or divisions which taught the courses specified. Please allow at least four weeks for the review process. During the summer and during semester breaks, the processing time could take longer than four weeks. You will be notified in writing with the decision.