Incomplete Grade Form printable pdf download

INCOMPLETE GRADE FORM

(Student completes top of form and signs, requests instructor complete and sign, then takes form to

appropriate division office. Dean signs, scans completed form and emails to student, faculty and registrar.)

The “I” grade is to be used only for verifiable unavoidable reasons when a student is unable to complete a course

within the normal course time.

To be eligible to receive an “I” grade, the student must (1) have satisfactorily completed more than 60% of the

course requirements and attendance and (2) must request the faculty member assign the “I” grade and indicate why

it is warranted.

The faculty member assigning an “I” grade must complete the section below stating (1) the reason for assigning the

grade; (2) the specific work to be completed and its percentage in relation to the total work of the course; (3) the date

by which the work must be completed; and (4) the default grade (B, C, D, F, P, R, or U) based upon course work

already completed. The A grade may not be awarded as a default grade. Completion dates may not be set beyond

the subsequent semester (to include summer term).

TO BE COMPLETED BY STUDENT

Student’s Name:

_________________________________________________________________

Last

First

Student EMPLID Number: _______________________

Semester/Year ____________________

Email address: ____________________________________

Course Name: __________________________________________

Course Number: __________________

(example: English 111)

(example: 51623)

Reason for requesting “I” grade: _______________________________________________________________________

___________________________________________________________________________________________________

TO BE COMPLETED BY FACULTY

List documentation provided by student to support “I” grade request: _____________________________________________

___________________________________________________________________________________________________

Work to be completed by student: ________________________________________________________________________

___________________________________________________________________________________________________

Date by which student work is to be completed: _______________

Default Grade (grade to be awarded if agreed coursework not completed within indicated time frame):

F (“A and “W” grades not available. Use mitigating circumstance form if appropriate for “W”.

Circle one: B

If no grade indicated final grade will default to “F”.)

Student signature: ______________________________________________

Date: ____________________________

Faculty signature: ______________________________________________

Date: ____________________________

Dean’s signature: ______________________________________________

Date: ____________________________

Incomplete Grade Form