Extension Request

Please review the form before you begin and complete the information in its entirety before submitting. It is not possible to save information and come back to it later. Completed requests for ECP and Richmond Campus students will be emailed to Dr. Carson Brisson, Associate Dean for Academic Programs. A copy of the completed request will be emailed to the address you enter below.

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*Campus you are enrolled in:
*Term extension requested (choose one):
Charlotte:
*Degree Program:
*Course Title:
*Professors:
*Have you consulted with your professor:
 
*Date of Emergency::
*Nature of emergency leading to failure to complete course requirements on schedule:
*Names and phone numbers/e-mails of any medical
professionals you wish to be contacted to discuss this request:
*Any role you believe UPSem and/or professor(s) played in
failure to complete course requirements by end of term:
*Specific list of all course requirements not completed to date, and, if noted on syllabus, original due date of each requirement for all class members: