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Extend Time to Complete Worksheet
Program Director / Advisor Recommendation
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Student Information
Program Selected
Full Name
First Name
Middle Name
Last Name
Student Email Address
UIW Student PIDM
Start Semester
Start Year
Completion Semester
Completion Year
Number of Credits Completed
Number of Credits Remaining
Reason(s) For Extending
Plan For Completion
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Program Recommendation
Recommend Time Extension?
*
No
Yes
Confirmed Entry Term
e.g. 201440 (Fall 2013)
Extension Term
e.g. 202570 (Spring 2025)
Change Course Catalog?
No
Yes
Current Catalog Identifier
e.g. 2013 - 2014 Graduate Catalog
New Catalog Identifier
e.g. 2024 - 2025 Graduate Catalog
Recommendation Comments
*
0/250
Program Director/Advisor
Signature
*
Trello Label
Office Use Email
Next Office Email
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