Version September 2008
REQUEST FOR PROGRAM EXTENSION
Graduate Education Programs
Student Name:
Student #:
UWO E-Mail:
Student Program:
Degree Requirements Outstanding:
Extension requested for the following term(s): G Fall 20_____ G Winter 20_____ G Summer 20_____
Procedures:
1. Complete this form, indicating term(s) (and year) that you are requesting (three maximum). Sign
the form and have your Program Advisor OR Thesis/DRP Supervisor sign it.
2. Submit this form to the Office of Graduate Programs & Research with a brief letter indicating the
specific reason for requesting a program extension AND a plan indicating timelines for the
completion of all degree requirements. Your letter (including timelines) must be signed by your
Program Advisor OR Thesis/DRP Supervisor.
3. Submit this form by the appropriate deadline: Fall Term – August 1; Winter Term – December 1;
Summer Term – April 1.
4. When your request has been approved, a copy of this form will be sent to you (part time students
will receive by mail; full time students will receive a copy in their mail box in the Graduate
Programs & Research Office).
_____________________________________ _______________________________________
Student Signature Date Advisor/Supervisor Signature Date
_____________________________________
Associate Dean Signature Date
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For Office Use Only
Extension Terms Approved: Fall 20_____ Winter 20_____ Summer 20_____
Manager’s Signature: _______________________________________ Date: __________________________
c.: School of Graduate & Postdoctoral Studies
