Office of Records and Registration
640 Bay Road, Queensbury, NY 12804-1445
CALL: 518.743.2279 | FAX: 518.832.7601 | EMAIL: registrar@sunyacc.edu
Report of Incomplete
Failure to complete the requirements of a course due to illness or other circumstances deemed acceptable by the instructor as beyond
the control of the student may result in a grade of Incomplete (I). In order to receive an incomplete grade, this form must be filed in the
Office of the Registrar with the signature of both the student and instructor. An incomplete grade will be changed to a standard letter
grade by the instructor if the student completes the requirements of the course before the end of the next regular (fall or spring) semester
or other grace period as established by the instructor. A grade of incomplete which has not been changed by the end of the grace period
becomes an F. It is the student's responsibility to contact and make arrangements with the instructor for completing the course
requirements. (http://catalog.sunyacc.edu/regulations/incompletes)
Semester: ❑ Summer ❑ Fall ❑ Winter ❑ Spring Year: _________ Date: ______________________
Student Name: __________________________________________________ Banner ID: _________________________________
Course Information:
Subject and Course Number
Faculty and Student Agreement:
Justification for assignment of incomplete (I) grade:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Requirements to be completed to remove the incomplete grade:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Completion and Grading Information:
☐ Option A: Student has until the end of the next regular semester (Fall/Spring) to complete the requirements listed above.
☐ Option B: The student will be required to complete the requirements listed above on or before (date) _____________
Failure to comply with the terms of the above will result in a final grade of: _______________
Incomplete Acknowledgement and Agreement: An incomplete grade will be changed to a standard letter grade by the
instructor if the student completes the requirements of the course before the end of the next regular (fall or spring) semester
or other grace period as established by the instructor. A grade of incomplete which has not been changed by the end of the
grace period becomes an F. It is the student's responsibility to contact and make arrangements with the instructor for
completing the course requirements.
The student and faculty signature’s below indicate the agreement information and approval of the requirements outlined to
complete the course named above.
Student Signature: _________________________________________________________ Date: _______________________
☐ Picture ID attached if sent electronically
Instructor Signature: _________________________________________________________ Date: _________________________
☐ Sent via SUNY Adirondack email account
For Registrar’s Office Use ONLY: Initials: ___________ Date processed: __________ Form Updated: 3/27/2020
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
