Incomplete Grade Request Form

In order to qualify for an Incomplete, you must have completed a significant portion of the course (including coursework, attendance, and participation). You may alternatively submit a course withdrawal or request a complete withdrawal.

Student Name:*

First Last

CWID (Campus Wide ID):*

Mines Email Address:*

Must be @mines.edu email address in order to submit this form!

Course Term:*

Select Academic Term

Course Year:*

Enter Academic Year

CRN:*

5-digits

Course Subject Prefix:*

EBGN, PAGN, MATH, etc.

Course Number:*

261, 301, 498A, 505, etc.

Course Title:*

List outstanding requirements remaining to be completed for this course:*

You must have completed a significant portion of this course to be approved for an Incomplete; list the remaining requirements

Estimated date by which the outstanding requirements above will be addressed:*

Know that your instructor may set due dates for individual assignments as needed--in addition to a final due date

Reason for Incomplete Grade Request:*

I am requesting an Incomplete (INC) grade for the course above for the following reasons

Instructor Name:*

First Last

Instructor Email:*

Must be @mines.edu email address in order to submit this form!

By submitting this request, I understand that*

This request is subject to approval and will require meeting with my instructor (contact your instructor immediately after your request has been approved to setup a meeting).
An Incomplete is restricted to cases in which a student has satisfactorily completed a significant amount of the coursework--including attendance and participation.
If approved, and if coursework is NOT completed by the deadline(s) assigned by my instructor, the 'INC' grade will be converted to an ‘F’ and included in my final GPA.
If approved, I understand that I am NOT to re-register for the course (or 'INC' will be converted to 'F').

All must be checked.

Hidden

Instructor Approval*

Approved
Denied

Hidden

List coursework/assignments to be completed for successful completion of course:*

Add additional rows as necessary. If individual assignment due date is same as final due date below, enter final due date

Work to be Completed:	Due Date:

Hidden

Date Coursework Must Be Completed By (Note: you may allow up to a year):*