OFFICE OF THE UNIVERSITY REGISTRAR
P.O. Box 1796 • Edmonton, Alberta, Canada T5J 2P2
Phone: 780-497-5000 • Toll Free: 1-888-497-4622
www.MacEwan.ca • recordsunit@macewan.ca
FREEDOM OF INFORMATION & PROTECTION OF PRIVACY
Protection of Privacy - The personal information requested on this form is collected and protected under the authority of Part 2 of the Alberta Freedom of Information and Protection of
Privacy Act and the Post-Secondary Learning Act. It will be used for the enrollment process and student management consistent with that purpose. This information will be entered into and
retained in the ofcial university student information system database. Direct questions expressly related to the collection and use of this information to the Associate Registrar, Records,
Ofce of the University Registrar, MacEwan University, 10700-104 Avenue, Edmonton, AB, T5J 4S2, telephone 780-633-3110.
AGREEMENT WITH RESPECT TO
INCOMPLETE GRADES FORM
PART 1
PART 2
PART 3
TO BE COMPLETED BY THE STUDENT
TO BE COMPLETED BY THE INSTRUCTOR
TO BE COMPLETED BY INSTRUCTOR AND STUDENT
STUDENT ID NO.:
FAMILY (LAST) NAME: FIRST NAME: MIDDLE NAME:
PROGRAM
Instructor’s Name: ____________________________________________________________________________
I AGREE TO ASSIGN A GRADE OF “IN” ON THE FOLLOWING CONDITIONS:
1. Course work must be completed by: _______________________________________________________ (SEE REVERSE)
PLEASE NOTE: IF EXTENSION IS GRANTED BEYOND THE ABOVE DATE A $50 FEE WILL BE CHARGED.
2. If course work is not completed on time, the Registrar shall record a grade of ___________________
GRADE MUST BE INDICATED OR “F” WILL AUTOMATICALLY BE ASSIGNED.
3.
THIS AGREEMENT HAS APPROVAL OF INSTRUCTOR, STUDENT, AND PROGRAM/SECTION HEAD
Student Signature: ________________________________________________________________
Date: __________________________________________
Instructor Signature: ______________________________________________________________ Date: __________________________________________
Program/Section Head of the Instructor’s Program/Section Signature: ____________________________________________ Date: ___________________________________________
I WOULD LIKE TO REQUEST A GRADE OF “IN”(INCOMPLETE) IN:
TERM _____________________________________ COURSE # _____________________________________ SECTION # _____________________________________ COURSE NAME: ____________________________
I WOULD LIKE TO EXTEND MY DEADLINE UNTIL: _______________________________________________ (SEE REVERSE)
REASON FOR REQUEST _____________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________
PERSONAL INFORMATION COLLECTION NOTICE
The personal information requested on this form is collected under Section.33(c) of the Freedom of Information and Protection of Privacy Act for the purpose of one or all
of the following: To determine eligibility for admission and financial assistance, to advise students about academic programs and to provide university services at MacEwan
University. Questions concerning this collection should be directed to the Lead, Privacy and Information Management at privacy@macewan.ca
NOTE: Please read instructions on second page before completing this form.
Signature not required if sent from a student @mymacewan.ca email account
OFFICE USE ONLY
RECORDS - PROCESSED BY: ______________________________________________________________________
DATE PROCESSED: _______________________________________________________________________________
Clear Form
AGREEMENT WITH RESPECT TO INCOMPLETE GRADES - POLICY C2020
REGULATIONS:
1. The grade of “IN” may be assigned if, at the end of a course, the student has not completed all the prescribed
course requirements due to unusual circumstances and the student has requested that this grade be assigned,
and has provided an acceptable reason for the request.
2. Incompletes must normally be completed within 30 days of the last day of the course/
3. Extensions may be granted in extenuating circumstances, but may not exceed 16 weeks following the end of the
course
PLEASE NOTE: IF AN EXTENSION IS GRANTED BEYOND THE ABOVE DATE, AN “EXTENSION TO AN
INCOMPLETE AGREEMENT” FORM MUST BE COMPLETED, AND A $50 FEE WILL BE CHARGED.
4. Students who fail to complete course work by the agreed deadline will have a grade assigned which is based on
work completed.
INSTRUCTIONS:
PART 1 - COMPLETED BY STUDENT
A) Complete Part 1 in full, including the reason why a grade of “IN” is being requested.
B) Consult with the instructor of your course. If your instructor is not available, consult your Program Department
Chair or Dean.
PART 2 - COMPLETED BY INSTRUCTOR
A) Determine whether you are prepared to permit a grade of “IN”
B) If so, complete Part 2. According to MacEwan University policy, “IN” grades must be cleared within 30 days of
the end of the course.
C) Specify all relevant conditions.
D) If you are not prepared to permit a grade of “IN”, record the reason in the appropriate location on the form.
PART 3 - COMPLETED BY INSTRUCTOR AND STUDENT
A) Sign the form and obtain the signature of the Chair of the instructor’s program/ department, and the student’s
signature.
B) Provide the student with a copy of the completed, signed form.
C) Submit the completed form to the Office of the University Registrar.
D) The Agreement with Respect to Incomplete Grades shall be retained on the student file and the recorded grade
entered if no notification of a change to the “IN” is received by the specified deadline.