Request for Program Extension to Complete Doctoral Degree
Student Information
Student ID
*
Student Email
*
Title
*
Mr.
Mrs.
Ms.
Student Name
*
Contact Number
*
Degree
*
Undergraduate
Masters
Doctoral
Program
*
Artificial Intelligence and Computer Engineering
Artificial Intelligence Innovation
Electrical and Computer Engineering
Technology and Creative Innovation
Current Semester
*
Fall
Spring
Summer
Year
*
Extension Request
Have you spoken with your advisor regarding the extension request?
*
No
Yes
If yes who
*
Current semester for PhD completion
*
Fall
Spring
Summer
Current year for PhD completion
*
The semester in which the Ph.D. is expected to be completed
*
Fall
Spring
Summer
The year in which the Ph.D. is expected to be completed
*
Reasons for extension
*
0/80
Students Signature
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: