\documentclass{article}

\begin{document}
\noindent \hfil \textbf{UNIVERSAL GRADE CHANGE REQUEST FORM} \hfil \par
\hfil \makebox[1in]{\hrulefill} University \makebox[1in]{\hrulefill} \hfil \par
\renewcommand{\labelenumi}{\makebox[1cm]{\hrulefill\ (\arabic{enumi})}}
\renewcommand{\labelenumii}{\makebox[1cm]{\hrulefill\ (\alph{enumii})}}

\noindent To: Professor \makebox[1in]{\hrulefill} \hfil From: \makebox[1in]{\hrulefill} \par

\noindent I think my grade in your course, \makebox[1in]{\hrulefill}, should be changed from \makebox[1cm]{\hrulefill} to \makebox[1cm]{\hrulefill} for the following reasons: \par

\begin{enumerate}
\item The persons who copied my paper made a higher grade than I did. 
\item The person whose paper I copied made a higher grade than I did. 
\item This course will lower my Grade Point Average and I won't get into:
	\begin{enumerate}
	\item Medical School
	\item Graduate School
	\item Dental School
	\item My Fraternity/Sorority
	\item The Mickey Mouse Club
	\item Tri County Tech
	\end{enumerate}
\item I have to get an A in this course to balance the F in \makebox[1in]{\hrulefill}. 
\item I'll lose my scholarship. 
\item I'm on a varsity sports team and my tutor couldn't find a copy of your exam. 
\item I didn't come to class and the person whose notes I used did not cover the material asked for on the exam. 
\item I studied the basic principles and the exam wanted every little fact. 
\item I learned all the facts and definitions but your exams asked about general principles. 
\item You are prejudiced against:
	\begin{enumerate}
	\item Males
	\item Females
	\item Catholics
	\item Protestants
	\item Moslems
	\item Jews
	\item Blacks
	\item Whites
	\item Students
	\item People 
	\end{enumerate}
\item If I flunk out of school my father will disinherit me or at least cut my allowance. 
\item I was unable to do well in this course because of the following illness:
	\begin{enumerate}
	\item mono
	\item broken baby finger
	\item acute alcoholism
	\item hangover
	\item pregnancy
	\item fatherhood
	\end{enumerate}
\item You told us to be creative but you didn't tell us exactly how you wanted that done. 
\item I was creative and you said I was just shooting the bull. 
\item I don't have a reason; I just want a higher grade. 
\item The lectures were:
	\begin{enumerate}
	\item too detailed to pick out important points
	\item not explained in sufficient detail
	\item too boring
	\item all jokes and not enough material
	\item all of the above
	\end{enumerate}
\item This course was: 
	\begin{enumerate}
	\item too early, I was not awake.
	\item at lunchtime, I was hungry.
	\item too late, I was tired
	\end{enumerate}
\item My (dog, cat, gerbil) (ate, wet on, threw up on) my (book, notes, paper) for this course. 
\item Other \hrulefill
\end{enumerate}

\end{document}