INCOMPLETE GRADE PETITION
FAMILY & CONSUMER SCIENCES
INSTRUCTIONS:
1. Fill out form before meeting with instructor to discuss petition. (Please print clearly)
2. Submit completed form with instructor’s signature to Department Chair.
3. If approved, return the original to the Family & Consumer Sciences department office and keep a copy.
4. See http://www.csus.edu/umanual/acad/umg05150.htm for policy regarding “I” converting to “F” if not
completed in the agreed upon time or before the end of 1 year. It is the student’s responsibility to follow up.
Name: (print) ______________________________ Student ID#:______________________________
Cell Phone: ____________________________
Personal email address: _____________________________
Course: ___________________________ _____________________
Number & Title
Semester & Year Course taken
________
________
______
Section
Units
Code
Reason for requesting an incomplete grade: (The reason should be serious, compelling and due to
unforeseen, fully justified circumstances. For more information, see CSUS catalog. Please attach
documentation and explanation.)
________________________________________________________________________________________________
________________________________________________________________________________________________
Detailed requirements and timeline/deadline for completing the course: This section is to be filled out with
instructor. Use attachment if necessary.
________________________________________________________________________________________________
________________________________________________________________________________________________
Student Signature: _______________________________________________ Date: __________________
Faculty use only:
Instructor, please provide the following:
Total points possible for course:____________
Student’s current points in course: _____________
Point value for each missing assignment/exam: 1.__________ 2.__________ 3.__________ 4.__________
Final letter grade without completing missing work:_________
□ Missing exam, assignment, and relevant grading rubric or key is/are attached
□ Grading scale for the course is attached
Instructor’s signature: ______________________________
Date: _________
Department Chair’s signature: _______________________
Date: _________
approved
□
□
denied
□
□
Upon completion, Instructor, please complete the following:
Final grade:______
Date Completed:_______
□ Grade Change form submitted
Date submitted:______