INCOMPLETE GRADE FORM
(Student completes top of form and signs, requests instructor complete and sign, then takes form to
appropriate division office. Dean signs, scans completed form and emails to student, faculty and registrar.)
The “I” grade is to be used only for verifiable unavoidable reasons when a student is unable to complete a course
within the normal course time.
To be eligible to receive an “I” grade, the student must (1) have satisfactorily completed more than 60% of the
course requirements and attendance and (2) must request the faculty member assign the “I” grade and indicate why
it is warranted.
The faculty member assigning an “I” grade must complete the section below stating (1) the reason for assigning the
grade; (2) the specific work to be completed and its percentage in relation to the total work of the course; (3) the date
by which the work must be completed; and (4) the default grade (B, C, D, F, P, R, or U) based upon course work
already completed. The A grade may not be awarded as a default grade. Completion dates may not be set beyond
the subsequent semester (to include summer term).
TO BE COMPLETED BY STUDENT
Student’s Name: _________________________________________________________________
Last First MI
Student EMPLID Number: _______________________ Semester/Year ____________________
Email address: ____________________________________
Course Name: __________________________________________ Course Number: __________________
(example: English 111) (example: 51623)
Reason for requesting “I” grade: _______________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
TO BE COMPLETED BY FACULTY
List documentation provided by student to support “I” grade request: _____________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Work to be completed by student: ________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Date by which student work is to be completed: _______________
Default Grade (grade to be awarded if agreed coursework not completed within indicated time frame):
Circle one: B C D F (“A and “W” grades not available. Use mitigating circumstance form if appropriate for “W”.
If no grade indicated final grade will default to “F”.)
Student signature: ______________________________________________ Date: ____________________________
Faculty signature: ______________________________________________ Date: ____________________________
Dean’s signature: ______________________________________________ Date: ____________________________
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit