University of Central Arkansas
Extended Studies Extension Request Form
Please fill out this form to request an extension for your course.
you fill out, read the
: A one-time, six-month extension may be granted for a $150 fee. The extension must be requested
the end of the initial six-month course period. The student that withdraws during the extension period will be issued either a ‘WP’ or ‘WF’ grade by the instructor. If the course work is incomplete at the expiration date, a grade of ‘F’ will be assigned.
UCA ID (Ex. B00213456)
Course Number (Ex. MATH 1360)
Date of This Request
Statement of Request
I understand the policy listed at the beginning of this form under IMPORTANT INFORMATION and I am requesting an extension of my Extended Study course BEFORE the initial deadline date of the 6 month course.
Confirmation of Request
By checking this box, I agree with the above statement.
Do Not Fill This Out