Center for Academic Success and Registrar ● PO Box 770 ● Georgetown, TX 78627
Phone: 512-863-1952 ● Fax: 512-863-1685 registrar@southwestern.edu
S:\Registrar\Forms\Petition for Incomplete Grade SU18
PETITION FOR INCOMPLETE GRADE
PLEASE CLEARLY PRINT ALL INFORMATION
STUDENT INFORMATION
Name:
Last First Middle
Student ID or SS#: SU Email:
COURSE INFORMATION
Instructor Name:
Course Number:
Course Name:
Semester: 20
I request that the grade of “Incomplete be granted for the above course. My explanation of the
emergency reason for granting this request:
I understand that the “Incomplete must be removed by 5:00 p.m. four weeks from the last day
of class in the semester in which the course was offered, or the grade becomes an F.
Student’s Signature Date
Approval/Instructor’s Signature Date
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