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Name: Course: BSAD 110 BSAD 112 BSAD 113 BSAD 114
E-mail:
Original exam date:
Requested date range for makeup:
Category of reason for extension: Illness--documentation provided Illness--documentation not provided Exceptional job situation Family emergency Court appearance Jury duty Travel for non-athletic university program Travel for university athletics Job interview Severe pressure from other classes Bad planning Other
Explanation of reason:
Documentation being provided to support claim: None From health care provider From university official From government official Other
Extensions for requested in this class, if any: Assignment(s) and dates. Note: This form is a not a petition for assignment extensions, but this question is being asked to assess a pattern. If none, please state so.
Approximate percentage of class meetings you have attended so far during the quarter.
If the above percentage is less than 80, reason(s) for low attendance:
Unless a specific waiver is granted in advance, a makeup exam is expressly contingent on complete attendance of all class sessions between the original exam date and the date of the make-up. Waivers will be granted only under exceptional circumstances.
Do you wish to apply for a waiver of the continuous attendance requirement? No Yes
If a waiver is requested, please state reason for this request:
Time this petition is being filed: One week or more ahead of the original exam date Before the exam date, but less than one week On the date of the original exam After the date of the exam
If this petition is filed less than one week prior to the exam, reason(s) for failure to petition earlier:
I certify that the all the above information is accurate to the best of my knowledge and that I have not made any exaggerations or other misrepresentations. I have given careful thought to all factual information represented. I understand that making false statements on this form may result in serious disciplinary measures.
In this form, please write "Understood":
