Name:  

E-mail: 

TA: 

Approximate percentage of lecture sessions you have attended: 

Approximate percentage of discussion section sessions you have attended: 

If you have missed an excessive number of class meetings (more than 2-3 during the quarter), please describe any extenuating circumstances:

Question number: 

Score you received       Score you believe you deserve: 

Are there specific parts of your answer for which you believe you did not receive credit?

Please indicate any parts of the answer to the question that you acknowledge to be missing from your answer

Please explain why you believe you deserve more points:

Is your belief that you deserve more points based on a comparison with another person's answer?  Yes No

If your petition is based on comparison with another student's answer and score, you must submit both your own answer and that of the other student for review.  Both answers will be reviewed and both scores may be adjusted up or down as deemed appropriate.  The exams will be reviewed by both the TA and by the instructor.  Please write "Understood." 

If your petition is not based on comparison with another student's exam, have you discussed this question with anyone else?  Not applicable Yes No

If you have discussed this question with anyone else, please indicate the names of all individuals with whom you have discussed this question:

If you have discussed this question with anyone else, please describe in detail what you have discussed:

Names of other student(s) whose exam(s) you are submitting for comparison:

Additional comments:

I certify that all the information I have given above is correct and understand that a review of my exam, and those of others, may result in either no change in the score, an increase in the score, or a decrease in the score for all exams.  If I have submitted someone else's exam for comparison, I certify that I have received that person's permission to do so.

Please write "Understood." 

Please (1) print out a copy of this form to be turned in to your TA with your exam and other supporting documentation and (2) then press the "Submit" button below.