Time Extension Request
In addition to this form, please provide a letter of support from your major professor that includes a detailed timeline for completion and
submission of the thesis/dissertation. FILING FEE STATUS IS INTENDED FOR ONE QUARTER ONLY. IN THE EVENT THIS PETITION
IS APPROVED, YOUR EXTENSION WILL BE FOR ONE ADDITIONAL QUARTER ONLY.
 Filing Fee
 PELP (Planned Educational
Leave Program)
Requesting extension for quarter:
Name:
UC Davis Student ID #:
Graduate Program:
Degree Objective:
E-mail:
Phone:
Student’s Signature:
Date:
Reason for extension request:
Quarter extension approved through:
Graduate Program Adviser’s Signature:
Date:
(Adviser with signing authority)
Print Graduate Program Adviser’s Name:
GRADUATE STUDIES SECTION
 Approved
 Denied
 Registrar’s Office notified of PELP or Filing Fee
 Approved through:
Associate Dean of Graduate Studies Signature:
Staff Initials:
Rev. 7/15
Date:
Date:
This version supersedes any earlier revisions.
GS-335