MJC Enrollment Services 435 College Avenue, Student Services Bldg. 1st Floor Modesto CA 95350 Phone (209)575-6102
Instructor Signature: Date:
Dean Signature: Date:
Today’s Date:
To be completed by student:
First Name: Middle Initial: Last Name:
Student ID: w Phone: Birthdate:
Course Information:
Instructor Name: Term/Year:
Course Name: Section #:
05/2019_SJB
Incomplete Grade Request
Submit completed form by email to MJCESeforms@mjc.edu or
in-person to Enrollment Services within 72 hours of grade nalization.
OFFICE USE ONLY
COMPLETED Instructor Signature: Date:
DID NOT COMPLETE Grade Awarded:
Sta Initials: Date:
Assignment/Exams to be completed Due Date(s)
Final deadline for completion of all coursework:
Final grade of will be assigned if the student does not meet the requirements for removal of the “incomplete” grade within ONE year.
Comments
(e.g. how work should be submitted, frequency of instructor-student meetings, etc.)
School Policy & Procedures for Incomplete Grades:
An incomplete (I) grade will be given only in cases in which course work could not be completed because of illness or for a cause judged
unavoidable by the instructor. Failure to complete regular course work by the end of the semester will not be reason for giving a grade of
Incomplete (I). When a faculty member approves a grade of (I) Incomplete, he or she: will enter on PiratesNet an incomplete and the in-lieu grade
that will be recorded if the student does not make up the work in the allotted time; will enter on PiratesNet the date on which the incomplete grade
will end and the in lieu grade will be awarded; will submit to the Enrollment Services Oce a written record (on the Incomplete Form provided) of the
conditions for removal of the (I) grade and the grade to be assigned if the work is not completed; will send notication via email to the student using the
college-issued student email outlining the work to be completed and timeline; will write the student’s grade when all work has been completed on the
Incomplete Form in the Enrollment Services Oce at least ve business days prior to the expiration date of the incomplete grade.
I have reviewed the conditions with the student and notied him/her in writing via email as outlined in policy stated above.
REASON FOR INCOMPLETE GRADE: Extenuating Circumstances Cause judged unavoidable by the instructor
Note: Extenuating Circumstances are: Veried accidents, serious illness or other circumstances beyond the control of the student.
Please describe reason Incomplete Grade is being requested by the student:
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