STUDENT REQUEST FOR INCOMPLETE GRADE
!NSTRUCTOR REVIEW AND RECOMMENDATIONS
ln.structor: List the ossignment(s) to be completed in order to remove the Incomplete Grode fro_m
th
e
transcript of the student. Be specific and provide acceptable grade level(s} required for successful
completion.
YES NO
□□
□□
I certify that this student has been in attendance and passing this course up to five (S)
weeks before the end of the semester.
The student request and reason for the request are acceptable to me.
Instructor
Signoture:. ____________ Date: (M)_/(D)/ ___ (Y)/ __ _
DEAN REVIEW AND RECOMMENDATIONS
Dean of Instruction
Signature: _________ Date: (M)_/(D)/ ___ (Y)/ ___ _
□□
I approve the request for an incomplete grade.
Routing Order: STUDENT· INSTRUCTOR· DEAN OF INSTRUCTIONAL SERVICES· FINANCIAL AID DIRECTOR- REGISTRAR
Copy or emoil to Student: ____ (Date) ____ ....e...__Registrar
Instructional Services Document I Student Request Incomplete Grade
DOD: 3.2.2011 KDrive: Instructional Services: Forms
