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IP Extension Request Form
Powercampus ID
Student First Name
Student Last Name
Student's Frontier Email
Student's Personal Email
Student's Phone
Class #
Degree
Specialty track
Advisor Name
Advisor Email
RCF Name
RCF Email
More Information Needed From RCF
More Information needed from Clinical Director
More Information Needed from Academic Advisor
I have checked my unofficial transcript in Self-Service, and Confirmed the course(s) that I am submitting on this form are on my transcript for last term or earlier.
Course Requiring Extension
Course Original Year of Enrollment
Course Original Term of Enrollment
Second Course Requiring Extension
Second Course Original Year of Enrollment
Second Course Original Term of Enrollment
Third Course Requiring Extension
Third Course Original Year of Enrollment
Third Course Original Term of Enrollment
Reason Extension is Requested
Additional Comments about the reason for the extension
Are you on a current performance plan for any issues?
Detailed Plans to complete the course (include proposed timeframe)
Type a value
Anticipated Course Completion Date (Please select a date that is M-F)
Select a date
...
Update ID
Submit
Update
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