Application for a grade of Incomplete in Internship
Applications must be received by the 12th week of class to be eligible.
Student's name________________________________________________
Social Security ##______________________________________________
Student e-mail ________________________________________________
Student address ______________________________________________
____________________________________________________________
TTN Site_____________________________________________________
Date of request _______________________________________________
Internship Site ________________________________________________
Site Supervisor _______________________________________________
Site Adjunct Instructor _________________________________________
Expected Date of Completion ____________________________________
Rationale for requesting an Incomplete (use the back of this sheet if necessary):
Attach a copy of the Learning Plan that details how every learning objective will be met, including thee number of hours. This Learning Plan must be approved and signed by your Site Supervisor and Site Adjunct Instructor.
NOTE: This request is not accepted without the Learning Plan and will be returned to the student.
Applications must be received by the 12th week of class to be eligible.
Student's Signature__________________________________________
SAI's Signature_______________________________________________
Site Supervisor’s Signature ________________________________________
