STUDENT: This form MUST be completed and submitted to your instructor BEFORE the
final day of exams. A separate form must be submitted for each course for which you request
an ‘I’- Incomplete grade. Fill out the top half of the form and give it to your instructor, who
will submit it to the Registrar’s Office in Silliman Hall.
Student Printed Name ________________________________ ID ______________
I am requesting an extension of time to complete the required work for the following course:
Course Number & Section: ____________________________ Term: ______________
Course Title: ______________________________________
*Student Signature: _____________________________________
*If the student is unavailable to fill out the form, the instructor or Dean of Studies may do so.
Extenuating circumstances justifying the incomplete grade:
INSTRUCTOR APPROVAL: I have agreed to grant the above student an Incomplete
grade. The following work is needed to complete the course requirements:
Date Due: _____________________ Grade if no additional work submitted: _________
The work for the course must be completed no later than two weeks after the last day of the
exam period. When the work has been completed, the instructor must submit the final grade
on the “Grade Change Form,which can be found on the Registrar’s website under Forms, or
at: https://www.union.edu/academic-affairs/policies-forms. For security purposes, please
refrain from emailing the grade.
Instructor’s Approval Signature: _______________________________Date______________