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Request of Incomplete Grade

I ___request that I be granted an Incomplete for this course listed below because___ ___ ___ I understand that an Incomplete is by definition an extension, and I will not be granted further time to complete my assignment(s) beyond the eighth week of the next regular semester. I also agree to abide by the published policies on Incompletes as delineated in the policy stated on the second page of this form. Signed: ___ Date: ___ *****

I [1]

because [1]

I [2]

because [2]

Signed

Date

Course Dept: ___ Number: ___ Section: ___

Course Dept

Number

Section

Course Title:___

Course Title

Semester: Fall Spring Summer Year:_____

Semester

Fall

Spring

Year

Student Name:___

Student Name

ID:___ Instructor:___

Instructor

Instructions for the removal of ‘I’

1. The following tests, materials, etc. must be completed: ___

1. The following tests, materials, etc. must be completed [1]

1. The following tests, materials, etc. must be completed [2]

2. The final grade will be calculated as follows:

2. The final grade will be calculated as follows [1]

2. The final grade will be calculated as follows [2]

3. The student's grade without this work currently is calculated to be a _____

3. The student’s grade without this work currently is calculated to be a

KSU Catalog, page 45, 2007-2008 – Policy on Incomplete Grades

A grade of “I” is to be assigned only for an unforeseen and extraordinary circumstance or situation which would have prohibited a student from completing a minor part of a course requirement, such as the final exam, one major exam, completion of a term paper or class project, or part of the requirements of a laboratory, and the student has made a request to the instructor prior to the end of the term. In some cases, a grade of “I” can be assigned when the course constitutes an “I” based on accrediting or certification requirements.

An Incomplete earned in any given term (summer session/semester) must be removed by the end of the eighth week of classes during the next regular academic semester; otherwise, the “I” will be changed automatically to a grade of “F.”

Instructor signature: _____ Date: _____

Instructor signature

Date

Student signature

Date

A copy of this form must be submitted to the Chairperson of the academic unit in which the course was offered at the time the 'I' grade is submitted.

1/3/08 JPC