Incomplete Grade Request Form

INCOMPLETE GRADE REQUEST FORM

TROY UNIVERSITY

Instructors must submit this completed form to the department chair at the time the incomplete grade is submitted. A copy of the completed form is subsequently emailed to the student at the email address below

Student Name: / ID Number: / Campus:
Address:
Phone Numbers: / Email Address:
Course Prefix and Number: / Course Title:
Term: / Faculty Name:

Student Completes This Section To Request and Qualify for an “Incomplete” Prior to the Instructor Submitting Course Grades

Note: (1) Your progress in a course must have been satisfactory (passing) before you found it necessary to request an incomplete grade; (2) The circumstances leading to your request must have been beyond your control; and (3) You will be required to provide documentation in order to justify your request.

I request that I be assigned an “Incomplete” (I) for the course indicated above. My reasons for the request are: (Attach documentation)

I realize the implications of being assigned an incomplete grade in this course: (1) A grade of incomplete may not be removed by repeating the course; (2) It is my responsibility to contact the instructor regarding the deadline for completing all course requirements. (3) I must adhere to the work completion deadline set by the instructor, but the deadline must not exceed NINE weeks from the date the incomplete grade is assigned; (4) The deadline applies whether or not I re-enroll for the semester following the assignment of the incomplete grade; and (5) Failure to clear the incomplete grade within the specified time period will result in the assignment of a grade of “FI” for the course.

Student Signature: / Date:

Instructor Completes This Section (Write on or attach additional sheets if necessary.)

Students Plan of Work:

I Approve Disapprove your request to be assigned a grade of “Incomplete”. (Attach course syllabus to approved request.)

Estimated grade in this course to date is / Percentage of course grade already earned
Completion Deadline / Please note, deadlines may not exceed 9 weeks from start date of next term or semester.
Description of Work to be Completed / Grading Weight / Deadline

Is a test required?  Yes  No If Yes, submit test with key to your immediate supervisor and retain a copy for yourself. The test submitted must be different than the one administered to the rest of the class.

The method of computing final grade (If explained in syllabus, you may attach syllabus):

Note: (1) The Completion Deadline must allow sufficient time to grade the material submitted by the student and calculation of the final grade; (2) In no instance may the final grade for this course be submitted later than the deadline for submitting grades at the end of the semester containing the Completion Deadline -- submit the final grade (P,A,B,C,D,F, FI) on a Change of Grade Form; and (3) Be sure that a copy of the course syllabus is available in the department chair’s office.

Instructor Signature: / Date:

Instructor mailing or email address for correspondence regarding removal of this incomplete grade:

Instructor Email:
Address
For Records
Use Only