Request to Retest

Name:

Date:

Homeroom Teacher:

Name of test you wish to retake:

Reflect

Previous Score _____________ Why?

Action Plan

3 activities I will complete in order to improve my understanding of this concept

 1.

2.

3.

Completed

When you have completed the three activities above turn in this sheet with the following:

• Original test (if you have not already returned it)

• Evidence of you completing the above activities (work, parent signature...)

Request

I request the opportunity to retest. I have worked hard to improve my understanding of this concept.

Signed: ____________________________________