UNION COLLEGE
OFFICE OF THE REGISTRAR
INCOMPLETE GRADE REQUEST
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 final grade. Supply the form 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:______________
Title:______________________________________
*Student Signature: _____________________________________
*If the student cannot fill out the form because of extenuating circumstances, it may be filled
out by the instructor or Dean of Studies.
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
examination period. When the work has been completed, the instructor should submit the
grade on departmental letterhead to the Registrar’s Office. For security purposes, please do
not email the grade.
Instructor’s Approval Signature: _______________________________Date______________
Instructor’s Written Name:___________________________________
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