STI

CHANGE OF GRADE FORM

Reminder: Any form of erasures will invalidate this form
This section is to be accomplished by the Faculty Member

STUDENT INFORMATION
Student Number Last Name First Name Middle Name
02000065509
BORLONGAN ADAGAIL JADE
School Year Program Classification Term: ❑1st ❑2nd ❑Summer
2020-2021 ❑Graduate ❑Tertiary ❑ Senior High School Grade/Year Level: 2ND YEAR
Class Number Program Title/Strand Course Code and Title
02000065509
BS HOSPITLITY MANAGEMENT PHED 1004-ML31(PHYSICAL EDUCATION4)

CHANGE OF GRADE
From (Old Grade) To (New Grade)
5.00 1.75
JUSTIFICATION
Briefly explain the justifiable reason/s for the change in the student's previous grades. Please provide a list of the student’s grades in the
course and documentation of how the final grade was calculated specifically, grading criteria, class record, and old student grade form. For
class record, attach the Summary of Class Record for Tertiary or SHS Class Record.

System Malfunction

Faculty Member’s Full Name and Signature Date Requested

John Michael C. Candelaria 09/11/2021

REQUIRED SIGNATORIES (Please ensure all fields required are completely filled out with supporting documents before signing.)
DESIGNATION PRINTED NAME SIGNATURE BASED ON STATUS DATE REMARKS
ENDORSED NOT ENDORSED
PROGRAM HEAD/
ASSISTANT
PRINCIPAL
ENDORSED NOT ENDORSED

ACADEMIC
HEAD/PRINCIPAL

ENDORSED NOT ENDORSED

SCHOOL
ADMINISTRATOR/
DEPUTY SCHOOL
ADMINISTRATOR
APPROVED DISAPPROVED
SCHOOL
PRESIDENT/SCHOOL
DIRECTOR
ENDORSED NOT ENDORSED
ACADEMIC
OPERATIONS
MANAGER
GRADES ARE POSTED GRADES ARE NOT
POSTED
STI HO ENCODER
GRADES PRINTED AND GRADES ARE NOT
ISSUED TO STUDENT PRINTED AND ISSUED TO
REGISTRAR STUDENT

Change of Grade Form | FT-AOG-004-00