Extension Agreement
(Please staple to the grade sheet for each grade of Incomplete [I].)
DATE: ___________________________________
TO: Peggy O’Neill, Associate Dean of Academic Affairs
This is to inform you that I have agreed to allow ______________________________________ (Student name – please
print) an extension to complete work in course # ________, __________________________________________________,
due to the following circumstances:
Brief explanation here: _______________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________.
The final or missing assignment is due no later than: _________________________
(Extension deadline)
Per the MSW Handbook, I may give a student up to one week to complete and submit this outstanding work. I agree to
review this work and submit a narrative evaluation and final grade for this student within one week of the extension due date.
If the above student fails to complete this outstanding work within the extension period, I agree to submit a grade and written
evaluation within one week of the deadline date, based upon the student’s achievement of course requirements as of the
deadline date.
INSTRUCTOR: _______________________________________________________________________________
(Instructor’s signature)
(Instructor’s name PRINTED here)