Request for Incomplete Extension


Per UW Regulation 6-720

If an Incomplete is already assigned by the Instructor, it must be removed by assignment of a final grade normally within a period of time not to exceed 120 days from the end of the semester in which the Incomplete was received.  If a grade is not assigned and received in the Office of the Registrar within the time limit, a grade of F will be automatically recorded to replace the temporary grade of X.  However, if, in the judgment of the Instructor, a student has suffered a problem that has precluded timely completion of required work, the 120-day limit for completing the course may be extended with the approval of the Instructor.  In such cases, this request must be received by the Office of Registrar prior to the deadline date indicated on the Authorization for an Incomplete form.

 *All areas are required and must be completed 

Student First Name
Student Middle Name
Student Last Name
Student SID#
Student Email Address
Instructor Name
Instructor Email Address

I request approval for an extension of time for my student to complete the following course:

Course Prefix
Course Number
Course Section
Course Title
Semester this Course was Originally Taken
Course Instructor Name

Briefly describe the reason you are requesting the extension:

State the coursework that now remains to be completed:

Date on or before which completed course work must be received by the Instructor:
Date on or before which the Instructor must file the Removal of Incomplete with the Registrar:

You are responsible for tracking the progress of your petition using the confirmation number received once you have submitted your petition.  Therefore, you may find it useful to print out the completed form for the tracking number and for your own personal records.  The electronic petition process can involve contacting a number of faculty/staff members.  For this reason please allow up to two weeks processing time.

I understand the applicable UNIREG and agree to fulfill the conditions established for assignment of a grade.  Further I certify that the information I have provided is correct to the best of my knowledge.  If my request is accepted, I agree to abide by the policies, rules and regulations of the University of Wyoming.  I further understand that the information submitted herein will be relied upon by the Officials of the University in determining my request.  WITHOUT CORRECT ELECTRONIC SIGNATURE AUTHORIZATION THIS REQUEST WILL NOT BE PROCESSED.

*Select Yes for Electronic Signature Certification

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