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Retake Request Form 
Students must complete the Retake Request digital form before the last full week of the trimester. Once students receive their scored test or quiz, one week will be given to make up the test or quiz; however, this may be adjusted upon the teacher’s discretion.  
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1.) What is today's date? *
MM
/
DD
/
YYYY
2.) What is your name? *
4.) What is the subject of the assessment? *
5.) What is the title of the assessment that you would like to retake? *
6.) What was your grade on the original assessment? *
7.) Explain where you struggled on the assessment. *
8.) Why do you deserve a retake? Explain. *
9.) What is your plan for preparing for the retake? Please answer the following statements and add any additional comments as needed.
Yes
No
I have reviewed and completed test corrections.
I completed and turned in all required assignments prior to the test.
I completed and corrected my study guide.
I will provide evidence of additional studying/preparation for the retake.
I need re-teach and extra practice – I’m confused about this topic.
I would like to schedule a meeting with my teacher to develop and review my plan for my retake.
Clear selection
10.) What additional studying/preparation for the retake do you plan to do? (ex. study notes, review games, request additional practice).  *
11.) I understand that one week will be given to make up the test or quiz; however, this may be adjusted upon the teacher’s discretion.  
Clear selection
12.) I understand that I need to complete this form and let my teacher know a request was made. *
Required
Submit
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