Bellaire High School Request for Retake
Student Name
First Name
Last Name
Student email:
example@example.com
Teacher:
Teacher's email: (Please enter carefully, if you mistype a teacher's email they will not receive this form.)
example@example.com
Subject:
Period:
Date of failure notification:
/
Month
/
Day
Year
Date
Grade on original test:
Date of retake request:
/
Month
/
Day
Year
Date
All of the following will be required before the retake is given:
Attend at least one tutorial
Submit all missing work for the grading cycle
Test corrections completed
Actions to be taken to avoid future retest:
*
I have discussed this retake opportunity with my parent(s).
Yes
No
Date
/
Month
/
Day
Year
Date
Preview PDF
Submit
Should be Empty: