Exam Review Request Form

Exam Review Request Form

This form initiates a formal request for review of an examination result. Complete all sections below and provide factual grounds and supporting material for the requested review. Submission of this form constitutes a binding request for administrative review subject to the institution's grading policies, fees, deadlines, and confidentiality requirements set forth herein.

Student Information

Course and Exam Information

Course Code:   Course Title:

Instructor:   Semester/Term:

Exam Type:   Exam Date:

Grade Received:   Component / Question(s) Affected (if known):

Request Details and Scope of Review

Type of Request (check all that apply):

Re-grade specific question(s) Clerical/mathematical calculation check Exam viewing (in-person or recorded) Answer key/marking criteria clarification Other (explain below)

Supporting Materials

List all supporting documents submitted with this request (e.g., graded exam copy, rubric excerpts, correspondence). Attachments must be legible and dated. Electronic submission may be required per administrative instructions.

Fees and Payment Terms

A non-refundable review fee may apply for certain types of review. Fees must be paid in full prior to commencement of the review. If a re-grade results in an increased grade, fee handling will be as stated below.

Term, Deadlines, and Termination

This request must be submitted within the institution's prescribed period following posting of the grade. Submission outside the prescribed period may be rejected unless exceptional circumstances are documented and accepted by the academic unit.

Date of Submission:    Days Since Grade Posted:

Confidentiality and Use of Exam Materials

All materials submitted and any exam materials made available during the review remain confidential and are for review purposes only. The applicant may not reproduce, copy, or disseminate exam content. Any violation of confidentiality may result in disciplinary action.

Governing Law; Remedies; Entire Agreement

This request and any administrative response shall be governed by the policies and procedures of the institution and applicable law. The administrative decision is final except as may be provided by the institution's published appeal rights. This form constitutes the complete written request and supersedes any prior statements or communications regarding the requested review.

Certification and Authorization

By signing below, I certify that the information provided on this form is accurate to the best of my knowledge. I authorize the academic unit to access my graded exam and related materials for the sole purpose of conducting the requested review and to communicate the outcome to the contact information provided. I understand that knowingly submitting false information may constitute academic misconduct.

I acknowledge and agree to the certification and terms above

Sign Now