Independent Studies Extension Request

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Independent Studies Six-Month Extension Request Form

Instructions:

Complete the form below and press submit
Include credit card information to pay $100 fee. If you wish to be contacted for other payment options, please check the appropriate box.
The form must be received by the due date of the course. No extensions will be granted after the class has completed.
Only one extension may be requested for each course. We are no longer able to offer 2nd extensions.

All fields are required.

First Name:

Last Name:

Student ID #:

Email:

Phone:

Course Number:

Section:

Course Title:

Please contact for credit card information

Card Type: Master Card Visa

Card Number:

Expiration Date: