SHIPPENSBURG UNIVERSITY - REQUEST FOR INCOMPLETE GRADE(S) FORM
INSTRU
CTIONS:
The grade of “I” (incomplete) may be requested if you are unable to complete the requirements of a course due
to a
serious illness, death in the family, or personal emergency (Note: refer to the “Incomplete Grade” policy in the
student handbook). Remember, substantiating documentation should be obtainable and may be required. You must
obtain an approval signature from each instructor indicating she/he will issue an “I” (incomplete) grade. To request an
incomplete for a course, submit this form directly to the instructor of the course. If you are unable to complete the
requirements for all your courses, submit this form to the Academic Dean of your college. If you are physically unable
to secure approval signatures for all of your courses, you must contact your Academic Dean’s office. If you do not
complete the work for a course in which you received a grade of “I” by the last day of classes before final exam week of
the next full semester, you will receive a grade of “F” for that
c
ourse.
Note:
When permission is granted by a faculty member, the approval signature affirms that the remaining
assignments/requirement will be communicated to the student.
PART I: To be compl
eted by the student
Student Name (print): SU ID #.
(Last Name, First Name)
Requesting incomplete grade for (indicate number of courses, or indicate ‘all courses’) __________ Term ________
(ex: fall 2014)
Please provide justification for this request:___________________________________________________________
List course(s): include title, course code (department, course, section, CRN), and instructor’s name.
NOTE: If incomplete grades are being requested for all courses, the student must obtain each instructor’s signature.
with CRN
(ex ENG250-01
CRN:20541)
(Intro to Literature)
Name
Instructor’s
Signature/Date
______________________________________ ____________________________
Student’s Signature
Date
PART II: Remember, if this request is for a grade of incomplete in all courses, the student must obtain the
signatures of each instructor before submitting this form to their Academic Dean.
If you are unable to
physically secure approval signatures for all of your courses, you must contact your Academic Dean’s office.
Approved
Denied
Academic Dean’s Signature Date
Note: Retain a copy for your records and submit the original to the Registrar’s Office.
R
evised and effective: 4/2020
