Form Fm 6029 – Fill Out and Use This PDF

MIAMI-DADE COUNTY PUBLIC SCHOOLS

GRADE CHANGE REQUEST FORM – SECONDARY SCHOOLS

NAME OF SCHOOL: Jorge Mas Canosa Middle School		WORK LOCATION #: 6771
NAME OF STUDENT:___________________________________ ID NUMBER:_______________GRADE:___________
TEACHER:________________________________________________________________________________________
PRINT NAME	SIGNATURE	DATE

DOCUMENTATION/PROOF OF GRADE MUST BE ATTACHED TO THIS FORM. PLEASE REFER TO PROCEDURES PAGE. PLEASE COMPLETE IN BLUE INK AND CHECK ALL BOXES THAT APPLY.

JUSTIFICATION:___________________________________________________________________________________

_________________________________________________________________________________________________

SCHOOL YEAR: __________SUBJECT:____________________________________________ PERIOD:___________

□ 1ST 9 WEEKS	□ 2ND 9 WEEKS		□ 3RD 9 WEEKS	□ 4TH 9 WEEKS		□ FINAL GRADE		□ SUMMER
		TYPE OF CHANGE		FROM		TO
		ACADEMIC
		EFFORT
		CONDUCT

REVIEWED BY:

	POSITION	PRINT NAME			SIGNATURE	DATE		COMMENTS
	COUNSELOR
	ACTIVITIES DIRECTOR						□ ELIGIBLE DUE TO GRADE CHANGE
	ATHLETIC DIRECTOR						□ ATHLETE	□ NON ATHLETE
							□ ELIGIBLE DUE TO GRADE CHANGE
	ASSISTANT PRINCIPAL
	GRADE CHANGE: □ APPROVED		□ DENIED
	PRINCIPAL:________________________________________________________________ DATE:_________________
		PRINT NAME			SIGNATURE
	PARENT NOTIFICATION REQUIRED AFTER FINAL PRINCIPAL SIGNATURE: METHOD OF CONTACT:_______________________
	DATE:______TIME:______ NOTIFIED BY:_____________________________ ________________________________
					PRINT NAME			SIGNATURE

GRADE CHANGE PROCESSED BY:

REGISTRAR:_______________________________________________________________ DATE:_________________

PRINT NAME

SIGNATURE

***EVERY EFFORT SHOULD BE MADE TO MAKE THE GRADE CHANGE IMMEDIATELY AND WITHIN THE CURRENT ACADEMIC YEAR.***

FM-6029 (2-12)

M-DCPS District Procedures for Initiating and Processing Grade Changes

1.A change of grade may be initiated by either a teacher or the principal. Every effort should be made to make the grade change immediately and within the current academic year.

In accordance with Board Policy 5410, Student Progression Plan and the United Teachers of Dade Labor Contract, Article XX - Section 8. Grade Change, please note the following: If the principal of a school feels it is necessary to change a pupil's grade in any subject at the end of the grading period, the principal shall consult with the teacher who issued the original grade and give his/her reasons for the necessary change to the teacher, in writing. If a change in grade is made, it shall be recorded as the principal's grade and not the teacher's grade.

2.To initiate a grade change, the M-DCPS Grade Change Request Form - Secondary Schools (grades 6-12) FM-6029 should be completed by the teacher.

3.The appropriate documentation supporting the reason for requesting a change of grade must be attached to the M-DCPS Grade Change Request Form. [Such documentation may include, but not be limited to, student work, teacher error, Board Policy, missing grade information, End of Course (EOC) assessments, etc.]

4.The M-DCPS Grade Change Request Form with attached documentation will be submitted to the staff members specified on the form to obtain the required signatures. These will include the teacher, counselor, activities director (senior high schools), athletic director (senior high schools), and assistant principal. The principal will indicate approval or denial of the grade change and sign the form.

5.The student’s parent must be notified of the grade change. The date, time, method of parent contact, and the name and signature of the person making the contact must be noted on the form.

6.Once the parent has been notified, the registrar will make the grade change in the Integrated Student Information System (ISIS) and will sign and date the form.

7.The M-DCPS Grade Change Request Form with attached documentation must be kept in the student’s cumulative folder (cum).

8.Extenuating circumstances requiring exceptions to these procedures must be approved by the Regional Center Superintendent.

FM-6029 (02-12)