Palm Beach State College
Academic Affairs
Incomplete (I) Grade Form/Agreement for Completion of Coursework
Campus: Belle Glade
Date:
Boca Raton
Lake Worth
Student’s Name:
Term/Year:
Palm Beach Gardens
Student’s ID#:
Course Number:
Ref#:
Course Title:
Instructor’s Name:
Department/Division:
Reason necessitating an Incomplete (I) Grade (Attach documentation):
Description of Assignment(s) to Be Completed:
(Please be specific and detailed. Tests should be placed in Testing Center. Explain other arrangements.)
Explanation of Make Up Work, Grading, and Calculation of Final Course Grade:
(Attach documentation and additional information.)
Student has been made aware (verbally or with copy of this form and signature below) that all work
referenced above must be completed within 30 calendar days of the next major term (fall or spring)
or the “I” will change to an “F.” For this student, that deadline is
(date).
___________________________ __________ _______________________________
Student’s Signature
Date
Student’s Contact Phone #
Instructor agrees (signature below) to perform those tasks listed above either with or for this student
on his/her own time and at no additional cost to the college. S/he will submit this form, with
syllabus, emergency documentation and other necessary information attached, to the appropriate
associate dean by the last day of the term in which the “I” is given.
___________________________ __________
Instructor’s Signature
Date
___________________________ __________
Associate Dean’s Signature
Date
July 2010