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Request for Make-Up Exam

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Request for Make-Up Exam
Name of Student Academic Year ____________________________________________________________________ Student Box Number Course in which the exam was missed __________________________________________________ Briefly state your request for make-up. Be sure to state in your request the reason why the exam was missed. IF YOU WERE SICK, A DOCTOR'S NOTE SHOULD BE ATTACHED.

Signatures
It is the student's responsibility to obtain all signatures. This form must be returned to the Graduate School of Biomedical Sciences, to the Attention of Carolyn Polk, within 3 days after the student initiates request. Student's signature Date student initiates request

Course Director Assistant Dean/Core Director

Approved Approved

Rejected Rejected

Date Date

If approved, Make-up Exam is scheduled on ________________________________________ . Please return this form to Carolyn Polk, EAD-824
An EEO/Affirmative Action Institution


				
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posted:11/3/2009
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