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JAMES HUBERT BLAKE HIGH SCHOOL
LOSS OF CREDIT PETITION
Directions: If you would like to request reinstatement of credit for a class, please complete the steps listed below.Your request for
reinstatement of credit must be submitted within ten days of the Loss of Credit being issued.If your administrator does not
recommend reinstatement of credit, you may petition the Principal for an alternative means of getting credit. Completion of this form
does not guarantee reinstatement of credit.
1.
NAME:___ _ __ __ _ __ __ __ __ _ __ __ __ __ _ __ ___ ___ ___ ___ __ GRADE:_ _ __ __ _ __ _ ID#__ _ _ _ __ _______________
TEACHER:___ ___ ____ ___ ___ ___ ___ __ ____ ____ __ COURSE TITLE:___ __ _ __ _ __ ___ __ ___ ___ __ ___ __ ___ __ __
2. Write a letter of appeal on this form addressing the reasons for your loss of credit. You have ten days to appeal the Loss of Credit.
You can refer to the prompt for assistance. Review your letter of appeal with your parents and have them sign below. (Attach another
sheet if you need more room).Before you write, think about these points:
What caused the loss of credit?
How you will change your attendance?
How you will improve your p
erformance on class assignments?
How you will plan to follow school policies and procedures?
How you will improve your future performance in class?
Now write a letter of appeal to your teacher requesting reinstatement of credit
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Parent Signature
Date
___________ _____________________________________________
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Student Signature
Date
After completion of Step 2, the student will deliver this form to the teacher of the LC’d class for a decision on the appeal. See Step 3
on the other side.
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