EXTENTION REQUEST FORM
Name:

 
Course:
Project or Paper Assignment:

 
Original Due Date:
New Due Date:

 
Reason for Extention Request:

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Authorized by:
Date:

 

IMPORTANT: THE STUDENT ASSUMES RESPONSIBILITY FOR THIS EXTENSION AND THE NEW DEADLINE. THIS FORM MUST BE SUBMITTED WITH THE PAPER/PROJECT OR A LATE PENALTY WILL BE ASSESSED. IF THE STUDENT LOSES THIS FORM, A LATE PENALTY WILL BE ASSESSED. THE PAPER AND/OR PROJECT ARE THE RESPONSIBILITY OF THE STUDENT AND IN NO WAY WILL THE TEACHER EXCUSE OR ACCEPT UNAUTHORIZED CHANGES TO THIS FORM OR THE PROCESS IT IMPLIES. I THE UNDERSIGNED ACKNOWLEDGE MY RESPONSIBILITY AND ABSOLVE THE TEACHER OF ANY LEGAL RESPONSIBILITY FOR MY ACTIONS, FOR MY PAPER OR FOR ANY INJURY I MIGHT INCUR IN THE PERFORMANCE OF THIS EXTENSION:
Student Name:
Date: