Optional Grade Extension Agreement
In the case of extenuating circumstances, and at the instructor’s discretion, a student may take
additional time to complete course work and/or exams after the student’s final grade is
submitted. Please complete this form and submit it to the Associate Dean for Student Success
in the Registrar’s Office.
Initial Grade
At the time that final grades are due, the instructor shall assign the grade that the student has
earned in the course. This form documents the expectations required for a subsequent grade
Changing the Grade
Should the student complete the additional requirements in a timely and satisfactorily fashion,
the instructor will submit a Change of Grade form to the Registrar’s Office. The Department
Chair must also sign the Change of Grade form. This is NOT the Change of Grade form.
Section A: Student and Course Information
Student’s Name: Student ID:
Course Name/Number: CRN:
Instructor’s Name: Semester Year:
Section B: Documentation, Requirements, and Deadlines
Reason for Extended Time:
Remaining Requirements:
Section C: Signatures
Student’s Signature: __________________________ Date: ___________________
Instructor’s Signature: ________________________ Date: ___________________
Department Chair’s Signature: __________________ Date: ___________________
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