Change of Grade Request
Date
-
Month
-
Day
Year
Date
Name
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First Name
Middle Name
Last Name
Student ID#
*
You must provide the correct course and section number below. Please check for accuracy. Provide Course Prefix, Course number, Section number, Course title, Sem hrs.
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Example: ENGL 1613 030 ENGLISH 6 sem hrs.
For the above course, I want to
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Request a withdrawal (W)
Have my grade entered in as a Pass/Fail (SF)
Change grading for another course?
Yes
No
You must provide the correct course and section number below. Please check for accuracy. Provide Course Prefix, Course number, Section number, Course title, Sem hrs.
Example: ENGL 1613 030 ENGLISH 6 sem hrs.
For the above course, I want to
Request a withdrawal (W)
Have my grade entered in as a Pass/Fail (SF)
You must provide the correct course and section number below. Please check for accuracy. Provide Course Prefix, Course number, Section number, Course title, Sem hrs.
Example: ENGL 1613 030 ENGLISH 6 sem hrs.
For the above course, I want to
Request a withdrawal (W)
Have my grade entered in as a Pass/Fail (SF)
You must provide the correct course and section number below. Please check for accuracy. Provide Course Prefix, Course number, Section number, Course title, Sem hrs.
Example: ENGL 1613 030 ENGLISH 6 sem hrs.
For the above course, I want to
Request a withdrawal (W)
Have my grade entered in as a Pass/Fail (SF)
I acknowledge the following:
I am modifying my final grade(s) which may have a financial impact on my balance due to KCC.
I have discussed the financial impact with the Accounting and Financial Aid offices.
I am withdrawing after the refund period, I will be obligated to fully pay for the course(s) - even if I never attended any class sessions.
I am responsible for all legal fees and collection costs KCC may incur.
I understand that by submitting this form, I agree that I have read and understand the implications with either requesting a withdrawal or having my final grade entered in as a Pass/Fail:
Signature
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Submit
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