*Retake Form

*Note: There's a printable PDF form of the retake form available on the bottom of this page.

Retake Request Form

Student’s Name: ______________________________

Date: _____________________

Activity Title: _________________________________

Date of Activity: ____________

Your Score: _________________

Goal for retake: ________________

Please state the reason you would like to retake this activity:

______________________________________________________________________________________________________________________________

_______________________________________________________________

1. I understand the purpose of a retake is to improve my knowledge and skills and I agree to take the responsibility to prepare myself.

2. I have read and understand the policy for retakes printed on the back of this page.

Student Signature _____________________

Parent Signature_____________________

Policy for Retakes

· Only forms completely filled out will be accepted.

· A different activity assessing the standard(s) may be provided.

· The higher score earned will be recorded.

· A student’s request may be declined at the teacher’s discretion.

Students must:

· Make the request on the appropriate form.

· Fill out the entire form.

· Turn in the form within three days of receiving the grade.

· Obtain a parent signature on the retake form.

· Retake the activity within one week from the return of the original. Date will be determined between the teacher and student.

· Retake the activity before or after school on the designated day.

Retake scheduled date/time: ___________________________________

Original score: __________________

Retake score: ___________________