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☐ ☐ ☐ ☐ ☐ PART I: TO BE COMPLETED BY STUDENT (Send form to instructor to complete the back of this form before submission to the Registrar’s Office) TO THE STUDENT AND INSTRUCTOR: This form must be submitted to the Registrar before the end of the term. Requests received after this date will not be processed and will result in a grade determined by work completed. NAME: STUDENT ID: Are you…
