Incomplete Grade Agreement Form
Assignments that are submitted beyond the due date may receive reduction of credit. When extreme circumstances exist,
participants who require additional time beyond the last day for submission of assignments for the term/session must
contact the instructor and request an extension. The instructor and participant will agree upon an extended due date
using the Incomplete Grade Agreement Form. Assignments not received by the date agreed upon will not be
accepted by the instructor and the participant's grade will be assessed accordingly.
Copies of the agreement should be copied and pasted into a Word or Text document and sent
via e-mail to the:
Please submit a copy of this contract directly to your instructor through e-mail prior to the end date of the term. Extensions for course work must be approved by the instructor.
Name: _____________________________
Course: ____________________________
Term: ____________________________
The above-named participant requests an extension for completion of course work that includes the following assignments:
- ______________________________
- ______________________________
- ______________________________
- ______________________________
Participant agrees to submit above listed assignments by (date) _________________ . Assignments completed beyond the original due date may receive reduction of credit.
Assignments received beyond contracted extension date will receive no credit and the participant's final grade will be assessed accordingly.
Student: ____________________
E-mail: ____________________
Instructor authorization:
Instructor __________________
E-mail __________________
