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SIMMONS UNIVERSITY
Office of the Registrar
300 The Fenway, Boston, MA 02115
Tel 617.521.2111 Fax 617.521.3144
PETITION FOR AN INCOMPLETE GRADE
(for undergraduates only)
Student Name: ______________________________________ Simmons ID #: ________________
Address (
where your copy of this petition will be sent)
: ____________________________________
Telephone number: __________________ ____________________________________
Course Information:
Course: ____________ Title: _______________________________ Semester: ______ Year: ________
Reason for Request:
(Medical documentation must be included with this petition if for reasons of health.)
Outline of Course Work to be Completed:
Date that the final grade will be submitted to the Office of the Registrar: _______________________
Student's Signature: ________________________________ Phone #:________________Date:_____________
Instructor's Signature: ______________________________ Phone #:________________Date:_____________
Adviser’s Signature: _______________________________ Phone #:________________Date:______________
A copy of this petition will be sent to the student and the instructor after the Administrative Board meeting.
The Administrative Board:
approved request for an incomplete
grade until
______________________.
tabled request pending medical
documentation. Please submit
medical documentation to the Office
of the Registrar before
__________________.
denied request for an incomplete
grade.
Grades for denied petitions
are due one week after review.
Grades not submitted by the deadline will
automatically be converted to "F.”
TO THE INSTRUCTOR: Indicate the
final grade below and return this copy to
the Office of the Registrar by the due date
noted.
FINAL GRADE: _______________________
SIGNATURE: _________________________
DATE: _______________________________
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