Department of Instructional Design and Technology
Western Illinois University
Request for Incomplete- Graduate Courses
The University’s policy states that an incomplete “may be given only when a
student, due to circumstances beyond his or her control, has been unable to
complete the course requirements within the official limits of the term. The
circumstances must be documented to the instructor’s satisfaction, and the student
should make arrangements with the instructor to complete the requirements of the
course within an agreed upon time frame. If the “I” is not removed by that time,
it will be changed to an “F.”
Student Name (Print) ________________________________________________
Student ID No: _____________________________________________________
Course Number and Title: ____________________________________________
Semester/Year: _____________________________________________________
Instructor: _________________________________________________________
State the reasons for requesting an incomplete (attach documentation)
List completed assignments:
List the assignments to be completed:
Date on which assignments are to be turned in: ___________________________
Student signature: ________________________ Date: _____________________
Instructor’s signature: _______________________ Date: ___________________
All documentation must be listed and attached