(Write a brief statement explaining your request)
By submitting this request, I acknowledge that I am requesting a change to my expected graduation date and it is my responsibility to discuss any financial implication with the undergraduate financial aid office or my graduate field. If delaying graduation, I understand that continued funding is not guaranteed.
Student Signature: ________________________________________ Date: _________________
Advisor OR Graduate Field Assistant Approval: _____________________ Date: _________________
Office Use Only
Date Received: ___________________
Office Approval (please initial): ________