WC Form

STUDENT REQUEST FORM - GRADE CHANGE TO WC

Students must read and sign this “WC” request form before submitting it to the Registrar. Once the request has been documented, the “WC” grade will be added to the transcript.
Date*

MonthDayYear
Date
Student Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Emergency Contact Name*

First NameLast Name
This is a request to receive a WC for the following course:
Term*
Course Name*
Course Number*
Section Number*
Faculty Name*
Campus*
Current Grade*
Reason for Grade Change*
By checking, I agree that I am the Student Name above and I am requesting a WC Grade.*

Agree
Signature

Clear
Should be Empty:

STUDENT REQUEST FORM - GRADE CHANGE TO WC