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Extenuating Circumstance Request Form
This form will be used for students to submit a request an extension for an assignment in class when they are unable to meet the original deadline date for submission due to extenuating circumstances only. Extenuating circumstances refer to a situation or situations beyond your control that have the potential to severely affect your academic performance or your ability to meet certain deadlines in your classes.
Today's Date
MM
/
DD
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YYYY
Student
Grade
Class
Teacher
Subject
Specific Assignment
Due Date of Assignment
MM
/
DD
/
YYYY
Reason for requesting extension
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