INCOMPLETE GRADE REQUEST (Version Update: May 17, 2000)

This form is to be completed and signed by all parties before assigning an "I."

Student Data:

Name:________________________________________________________________________

Address:______________________________________________________________________

City:_____________________________ State_________________ Zip____________________

Social Security Number:__________________________________________________________

Course Information:

Course Name:__________________________________________________________________

Course Number:_____________________________CRN:_______________________________

Professor's Name:_______________________________________________________________

Professor's Phone Numbers: work____________________ home_______________________

Professor's email address_________________________________________________________

Work that needs to be completed:

Date upon which work will be completed:__________________________________________

* policy states that period of time to complete work may not be exceed the long semester following the "I"

Calculation of grades: (here, present (1) all grades of student, (2) which are missing, and (3) the formula for calculating the grades when all is complete.

Signature Sheet

I understand and agree with the conditions stated above. Further, I understand that if I do not complete the work within the stated time period, I will receive a grade of "F" for the course.

Student's signature___________________________________ Date:____________________

Professor's signature__________________________________ Date:____________________

Please attach the following:

Course syllabus

Any exam to be given (and grading key)

Any paper assignment (include grading criteria)

Other relevant information

*3 copies are to be made of these 2 sheets (student, professor, department office).

One complete packet to include any tests, assignments, syllabi and grading key are to be placed in chair's office in sealed envelope. Professor administers tests, grades papers if that is possible. Otherwise, assistant chair in that discipline area manages the process. (Sept. 14, 1999).