Student: _____________________________________ Hr.

____ Assessment: _____________________________

Todays Date __________ Retake form & assignment due by _________ Test Retake Date ___________

ORIGINAL TEST GRADE ________ CURRENT LANGUAGE ARTS GRADE _______

Retake Policy and Requirements:

Request must be signed, completed and returned by the date listed above. This includes the
additional assignment to demonstrate effort to attain mastery learning.
All assignments for this unit must be turned in. ______ Currently missing assignment(s)
The retake will not be identical to the original test.
The higher grade between the original and the retake will be recorded in Power School.

**************************************************************************************************

Requirements for the Retake

PARENTS: Please check one, sign and return by the due date. Thanks so much for your support!

Parent Signature
_____ The additional assignment is complete, signed by parent,
and attached to this form to re-take the test. _____________________________
________ Missing work is also complete and attached.
Date ___________________

OR

Parent Signature
_____ We understand that a retake is available,
but we have decided not to retake it, or the _____________________________
requirements were not met in order to take the test.
Date __________________

******************************************************************************************************************
_____ All assignments turned In
_____ Additional assignment complete (Returned with signed retake form by due date)
_____ All requirements have been met for the retake _____________________________________
Teacher Signature

Retake Test Grade: ________