Request for Consideration of Late or Missed Assignment(s)

• Instruction:
  1. choose a reason for the missed evaluation
  2. print out this form and fill it out Part A
  3. print out a rubric or marking scheme for the assignment if available and attach to this form
  4. negotiate status and new due date with teacher and have teacher fill out Part B
  5. complete work (if required)
  6. complete Part C
  7. estimate mark if applicable in Part D
  8. hand in completed work (if applicable), this sheet, and rubric or marking scheme (if applicable) directly to teacher. Do not leave on desk or anywhere else.

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Part A

Student Name:________________________Course:________Grade _______Period______

Date of this Request:_____________________

Name of Assignment:____________________________________________

Reason for Missed Assignment: Choose One Illness - Specify: TAP, tap teacher, note on file in tap? Sport Event - Specify; date, event, sport coach Family Event - Specify: TAP, tap teacher, note on file in tap? Classroom Equiipment Issue - Please Specify Difficulty Learning or Completing Assignment on time Not On Task during class time Have Progressed but wish to do more Extra Curricular Activity - Specify event, person in charge Other Please Specify

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Part B

Status Review to be Completed by Teacher With Student

First Notified Date____________________________

Time Sensitive

• excused
  • make up on New Due Date ___________________
  • omit
• not excused
  • omit
  • zero assigned (notify department head)

Not Time Sensitive

• disposition
  • extension to New Due Date ______________
  • omit
  • mark reduction ____________
  • zero assigned (notify department head)

Teacher Signature__________________________________

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Part C

Student Signature_____________________

Parent Signature__________________

Parent Signature Required __Yes___No

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Part D

Actual Handed In Date ________________ Student Mark Estimate__________

Final Mark____________