Forms & Documents

Downloadable and printable forms for appeals, superintendent determinations, safety net documentation, and parent communications.

Appeal to Graduate with a Lower Score on a Regents Examination

Official form for appealing Regents exam scores. Appeals are limited to 2 exams total.

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General Appeal — All Students (scores 60–64)

Appeals a score of 60–64 to count as 65 (passing) toward a Regents or Local Diploma.

Student must have taken the exam at least 2 times
Student must have participated in academic intervention services
Student must have passed the course associated with the exam
Appeal must be reviewed and approved by the school appeals committee

Committee Verification:

☐ Exam taken 2+ times (dates: ________, ________)

☐ Academic intervention documented

☐ Course passed (final grade: ____)

☐ Appeal approved by committee

Committee Chair Signature: ________________

Date: ________________

Low-Pass Appeal — SWD Only (scores 52–54)

For students with an IEP or 504 plan. Appeals a score of 52–54 to count as 55 toward a Local Diploma.

Student must have an active IEP or 504 plan
Student must have taken the exam at least 2 times
Student must have participated in academic intervention services

⚠ 504 Students: Safety net usage must be checked off on the student's 504 accommodation plan before it can be applied.

Superintendent Determination of Graduation with a Local Diploma

For students with an IEP only (not 504 plans) who are not eligible through standard pathways.

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Pathway A: CDOS

Student has a CDOS Commencement Credential but did not pass required Regents exams.

Pathway B: ELA + Math

Student scored at least 52 on the ELA Regents and 52 on one Math Regents.

Superintendent Review Checklist:

☐ Student has active IEP (not 504)
☐ Parent/guardian request for superintendent determination submitted
☐ Full academic record reviewed
☐ All Regents exam attempts and scores documented
☐ Safety net eligibility evaluated (low-pass, compensatory, appeal)
☐ CDOS credential status confirmed (if applicable)
☐ ELA score ≥ 52 AND one Math score ≥ 52 (Pathway B)
☐ Coursework and attendance records reviewed
☐ Written determination with rationale signed by superintendent

Superintendent Signature: ________________ Date: ________________

Parent Request Form Letter

Template letter for parents requesting a graduation eligibility review. Copy and paste, then fill in the bracketed information.

[Date] To: Superintendent [School District Name] From: [Parent/Guardian Name] Re: Graduation Pathway Review & Superintendent Determination — [Student Name], Grade [X] Dear Superintendent, I am requesting a graduation pathway review and superintendent determination for my [son/daughter], [Student Name], who is currently in grade [X] and has an active IEP. Please review [his/her] full academic record, Regents exam scores, and transcript to determine which diploma type(s) and graduation pathway(s) [he/she] is eligible for, including any applicable safety nets, appeals, or the superintendent determination pathway. [Optional: Include specific concerns about Regents exam scores.] Thank you for your assistance. Sincerely, [Signature] [Parent/Guardian Name] [Phone Number] [Email Address]

Compensatory Safety Net Checklist

For SWD students only. One exam scored 45–54 can be compensated by another required exam scored 65+. Only one exam may be compensated.

Eligibility Checklist:

☐ Student has an active IEP or 504 plan (SWD)
☐ One Regents exam scored between 45–54
☐ Another required Regents exam scored 65 or above
☐ Only one exam is being compensated
☐ Total appeals across all exams does not exceed 2
☐ The 65+ score can be in any subject area

⚠ 504 Students: Compensatory safety net usage must be checked off on the student's 504 accommodation plan before it can be applied.

Example:

A student scores 48 on the Algebra I Regents and 72 on the Living Environment Regents. The 72 compensates the 48, and the student receives a Local Diploma.

Quick Reference: Safety Net Score Ranges

Score Range	Who	Result
85–100	All	Passing — eligible for Mastery designation
65–84	All	Passing
60–64	All	Appeal to 65 (2+ attempts required)
55–64	SWD only	Low-Pass Safety Net (automatic for Local Diploma)
52–54	SWD only	Low-Pass Appeal to 55 (2+ attempts required)
45–54	SWD only	Compensatory (needs 65+ on another exam)
0–44	All	Not passing — no safety net available