CEPSE / Doctoral Program in Counseling Psychology / Request for Extension of Time to Complete Degree Requirements

Request for Extension of Time to Complete Degree Requirements

College of Education -- Advanced Graduate Studies

Part I.

This section and reverse side to be completed and signed by student

________________________________________	______________________	Program level: ___Ph.D. ___ Ed.S.
Name of Student	PID number

Advisor: _____________________________ Semester and year of admission to program: _________________

Total credits completed ______ ; 999 ______ ; GPA _______ ; Date of Comps: ___________________________

Initial date of courses applied to program __________________

Program requirements to be completed during the time extension:

Courses: _______________________________________________________________________________

Examinations: _________________________________________________________________________

Residency: _____________________________________________________________________________

Dissertation: ____________________________________________________________________________

If granted a time extension, I will complete the specific requirements above during the specific semesters indicated:

Courses: semester and year: _______________________________________________________________________

Examinations: semester and year: __________________________________________________________________

Residency: semester and year: _____________________________________________________________________

Dissertation: semester and year: ___________________________________________________________________

___________________________________________________________________ __________________________

Signature of Student Date

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This section to be completed and signed by academic advisor--Advisor signature required Parts I & II.

Recommended action: ____ Refuse time extension and withdraw student from program

____ Extend time through ____ semesters under following conditions:

______________________________________________________

_________________________________ ____________________

Advisor Signature Date

Advisor should append a statement justifying this request, attending to the currency, coherence, and integrity of the student’s program. Return to Cassandra Book, Student Affairs Office, 134 Erickson Hall, MSU., East Lansing, MI 48824-1034.

Approved by Dean: Signature/Date: __________________________________________________

Recommended action, if any: ______________________________________________________________________

Part II.

Proposed Plan For Extension of Time To Complete Degree Requirements

Calendar of Estimated Progress Through Remainder of Degree Requirements: ( Student should be specific in providing goals/objectives to be completed during extension, listing dates to complete all remaining degree requirements--use additional pages as needed):

__________________________________________________________________________________________________

_________________________________________________________________________________________________

__________________________________________________________________________________________________

_________________________________________________________________________________________________

__________________________________________________________________________________________________

_______________________________ _________ ____________________________ ___________________

Student Signature Date Advisor Signature Date

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