Assignment Extension Application

If a student feels that circumstances beyond his/her ability to control, or to prepare for, should prevent him/her from completing an assignment by the specified due date, then the student is invited to complete and submit this application for approval by the course instructor. This form must be submitted at least four school days in advance of the due date.

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:_____________________________________________________________
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Sponsor's Name:_____________________________________________________________
Sponsor's Signature:_____________________________________________________________
Sponsor's Phone No.:_____________________________________________________________
Approved: _________________________________         Date: ___________________

For course instructor's file.
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Student Receipt
Student Name:_____________________________________________________________
Assignment: _____________________________________________________________
Assigned Due Date: ____________________        Requested Due Date: ____________________
Approved: _________________________________         Date: ___________________