Students should note that an extension application must be sponsored by an individual who can corroborate the student's need for an extension. For example, a health issue should be sponsored by a physician or guardian. The sponsor's name, signature, and phone number must be provided.
It should also be noted that an extension must not be considered to be in force until such time as this form has been completed, submitted, and approved by the course instructor.
| Student Name: | _____________________________________________________________ |
| Course: | _____________________________________________________________ |
| Assignment: | _____________________________________________________________ |
| Assigned Due Date: | ____________________ Requested Due Date: ____________________ |
| Reason for Request: | _____________________________________________________________ |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| _____________________________________________________________ | |
| Sponsor's Name: | _____________________________________________________________ |
| Sponsor's Signature: | _____________________________________________________________ |
| Sponsor's Phone No.: | _____________________________________________________________ |
| Approved: | _________________________________ Date: ___________________ |
For course instructor's file. |
| Student Name: | _____________________________________________________________ |
| Assignment: | _____________________________________________________________ |
| Assigned Due Date: | ____________________ Requested Due Date: ____________________ |
| Approved: | _________________________________ Date: ___________________ |