Name: ___________________________________________________ Date: _____________________________ Period: ________

Algebra 1 Retake Request Form

I would like to retake ______________________________________. Original Grade: ______________.

Why are you requesting a retake of this test? Explain and be thoughtful in your answer. Do not
just say “because I want a better grade”, or “I didn’t get it”. Why did you do poorly in the first
place? Be honest and detailed in your answer.

What algebra skills do you need to review in order to be more successful this second time? Be
specific in your answer.

In order to prepare for this retake…

1) I have completed the full test corrections on a separate sheet of paper (attach them).
Yes _____ No ______
2) I have completed 80% of the assignments leading up to this quiz (check your grade in IC).
Yes _____ No ______
3) I have attended the Homework Center after school on these dates: ____________________________________
Yes _______ No _______
4) I have come in and asked for help during tutorial or signed up with a peer tutor.
Yes _______ No _______ How many times? __________________________________________________________
5) I have come in for help during lunch, before, or after school on my own time.
Yes _______ No _______
6) I have looked over all of my guided notes and Springboard lessons and RE-TRIED the problems I
don’t understand on a blank sheet of paper (you must attach your evidence).
Yes _______ No _______
7) I went on Ms. Voinea’s website and used the resources available to me.
Yes _______ No _______
8) I have looked up videos and examples online to try to gain more knowledge about this topic.
Yes _______ No _______

I have given 100% effort and deserve the right to retake this quiz for a maximum score of 70%.

Student Signature: ___________________________________ Parent Signature: _______________________________

 Students, Please read and initial below.

All retakes are at teacher’s discretion. Every attempt will be made to ensure that
individual students are treated fairly; however, the opportunity for retakes should
not be taken for granted nor abused by the student.
Initials: ___________

This retake policy has been established on the premise that simply assigning a
student a poor grade on a quiz and “moving on” does not address the circumstances
that resulted in the student’s poor grade. This process is to address any unforeseen
difficulties that may have existed at the time of the initial assessment and to also
work to adapt habits and strategies that will improve the student’s approach to
learning so that future retakes are not necessary.
Initials: ___________

Only one retake is allowed per semester, at the teacher’s discretion. The student
must have demonstrated full commitment to learning in this class, and has
submitted 80% of all his/her assignments, as stated in the class syllabus.
Initials: ___________

This policy is not intended as a way to “work” the system. This is not a way for a
student to change a “B” to an “A”. It is for those students who have shown effort and
dedication in this class, and deserve the opportunity to change their “F” or “D” to a
passing percentage of up to 70%. The retake is not a last-minute grade-saver.
Initials: ___________

The retake test will not necessarily resemble the original test, and might be more
challenging due to the extra time allotted to the student to improve their skills. Each
retake will come from a bank of questions and might be similar, or entirely different
than the original test to ensure that the student truly prepared for the retake and
did not simply memorize the format of the questions.
Initials: ___________

The retake score will replace the original quiz score if it is higher. If the student does
worse on the retake, then the student’s parent will need to be contacted for a
teacher conference to develop an parent/student/teacher action plan to support the
student.
Initials: ___________