THE STATE UNIVERSITY OF NEW JERSEY

RUTGERS

Campus at Camden

OFFICE OF THE REGISTRAR

311 North Fifth Street   •   Camden   •   New Jersey  08102-1405

856/225-6053   •   Fax  856/225-6453   •   RTTRS 856/225-1999

STUDENT AND COURSE INFORMATION

Student Name: ______________________________   Student ID #: ___________________________

Term Course was Offered:  �Winter    �Fall    �Spring    �Summer  Year: ________

COURSE TITLE

 UNIT

SUB #

CRSE #

SECTION

CREDITS

INDEX #

I request one-year extension in order to complete required work and convert my INcomplete grade to a letter grade.

Reason for request:

I understand that if I fail to accomplish this conversion within the one-year extension, my grade will then remain an INcomplete on my permanent record.

Student’s Acknowledgment Signature: _________________________________ Date _____________

Note:  Grade changes are processed immediately upon receipt in the Registrar’s Office.  Grades can be

           viewed at http://registrar.rutgers.edu or RTTRS: (856) 225-1999.

INSTRUCTOR’S APPROVAL

The above named student is aware that I allow the extension of an INcomplete grade until the following:

(Month) _____/(Day)______/(Yr.)______ 

After this date, I understand that the INcomplete will remain permanent on the student’s record if a change of grade form is not received by the Registrar’s Office prior to the above deadline.

Instructor Name (Print)                                       Signature                                           Date

 Graduate School Director/Dean Authorization

Graduate Director (Print) _________________________ Signature _________________Date _______

Graduate Dean (Print)____________________________ Signature _________________ Date_______