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 ofcial university student information system database. Direct questions expressly related to the collection and use of this information to the Associate Registrar, Records,
Ofce 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: _______________________________________________________________________________
