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COURSE EXTENTION REQUEST FORM:

1. Students Name:


2. ID #


3. Degree Program: ___________________________________________________

4. Course Name and Number:


5. Current Date:


6. Please indicate course that is incomplete at time of end of semester: ________________________________________

7. Please provide details as to the reason for the request of extension, you will be granted a one month extension, if approved, unless you have further extenuating circumstances, please provide supporting documents, such as doctors note, etc where necessary, submit to your Student Services Advisor at TDLI.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. PLEASE NOTE: YOU MUST COMPLETE THE CURRENT COURSE, AND YOU MUST REGISTER FOR YOUR NEXT SEMESTER CONCURRENTLY (AT THE SAME TIME).
All course work and examinations must be completed prior to graduation and convocation.

9. Student Signature and Date:


10. Student Services Advisor Signature and Date:


11. Approval Granted, Note Length of Time Granted:


Presidents Signature and Approval:


END OF COURSE EXTENTION REQUEST.