Original – Registrar’s Office Copy – Student Copy - Instructor
Graduate Student Petition for:
Incomplete Grade
Extension of an Incomplete Grade
All sections of this form must be fully completed for the petition to be reviewed.
Name: _________________________________ Student ID# (or Last Four of SSN):_______________________________
Address: _______________________________________________ Telephone: ______________________________
Email: _________________________________________________ Other Phone: ____________________________
Advisor: ____________________________________ Program:____________________________________________
INFORMATION TO BE COMPLETED BY STUDENT AND INSTRUCTOR
Term: Summer Fall Spring _______ Year
Course No./Title:_______________________________________ Instructor: ________________________________
Outline the student’s responsibilities for meeting course requirements:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Date when student must Date when final grade is
submit all work to the instructor: __________________ due in the Registrar’s Office: __________________
Signatures: The signature of the instructor signifies approval of this petition.
NOTE: By signing below, I understand that upon receipt of the grade given for this course, academic standing processes will be completed for the
semester in which I originally registered for the course. Should my overall GPA fall below a 3.0, I will be subject to a change in academic standing
for the original and subsequent semesters.
__________________________________________ __________________________________________
Student Signature/Date Instructor Signature/Date
__________________________________________
Program Director/Date*
*
Program Director signature only needed for an extension of an incomplete grade. Signature indicates approval.
If the Program Director is the course instructor, then the Department Chairperson’s signature is required.
SPECIAL NOTES AND FURTHER INSTRUCTIONS
If a final grade is not submitted by the deadline, AND there is no petition on file in the Registrar’s
Office approving an extension of an incomplete grade deadline, THEN the grade of “F” will be
assigned by the Registrar’s Office. Deadlines are listed on the Registrar Academic Calendar.
All course requirements must be successfully met, including resolution of “I” grades, in order to
participate in commencement exercises.
The instructor will distribute the copies of this form as indicated below.
An extension of an incomplete grade should only be allowed for extremely serious
circumstances. The work must be completed and a grade must be reported no later than the end
of the semester following the issuance of the original "I" grade (i.e. an extension of an "I" grade
issued in the Fall semester would be due by the end of the Spring semester). Granting of an
extension is at the discretion of the Instructor and Program Director.
Office of the Registrar
Smyth Hall, Room 1
4245 East Ave
Rochester, NY 14618
Phone: 585.389.2819
Fax: 585.389.2612
