Test Score Re-evaluation Request Form
Use this form to request a review of a test score by providing your details, exam information, the specific scoring concerns, and any supporting materials.
Student and Exam Identification
Student Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Student ID / School Identifier
*
Program, Grade, or Class
*
Instructor / Examiner Name
Test / Exam Title
*
Course / Subject
*
Exam Date
*
-
Month
-
Day
Year
Date
Original Score
*
Re-evaluation Details
Reason for Re-evaluation
*
Addition/marking error
Missing points
Answer key mismatch
Unanswered question reviewed
Unclear rubric application
Other
Detailed Explanation
*
Questions in Dispute
*
Urgency / Impact
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
Preferred Outcome
*
Score confirmation
Partial adjustment review
Full re-grade
Explanation only
Supporting Information and Submission
Supporting Documents or Evidence
Upload a File
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Choose a file
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Preferred Contact Method
*
Phone
Email
Alternate Contact
Other
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Best Time to Contact
Please Select
Morning
Afternoon
Evening
Weekdays Only
Anytime
Acknowledgement
*
I confirm the information provided is accurate.
I understand this request is for review of scoring and does not guarantee a score change.
Submit Request
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