Incomplete Form (Temporary COVID-19 Relief) Question Title * 1. Course Prefix and Section (ex. WRT 101-2) Question Title * 2. Course Name Question Title * 3. Instructor Name Question Title * 4. Student Name Question Title * 5. Student ID Number Incomplete Requirements. (All answers must be answered with a "Yes" in order for an incomplete to be given). Question Title * 6. The student was in compliance with the course attendance policy. Yes No Question Title * 7. There was unavoidable circumstances that prohibited the student from completing the course Yes No Question Title * 8. If answered "yes" to question 7 describe the circumstances. Question Title * 9. The student completed at least 50% of the course. Yes No Question Title * 10. When the student was active in course, the student had a letter grade of "C" or above. Yes No Incomplete Plan and Information Question Title * 11. Verification. As the Instructor I explained to the student that they have until the end of the following semester to complete the incomplete if the incomplete is awarded. Yes No Question Title * 12. Verification. I as the Instructor of Record understand that by awarding an incomplete (I), that I am responsible for this plan and following through with the student to the end of the incomplete, regardless of whether I have an Instructor Contract with Tohono O'odham Community College in the following semester. Yes No Question Title * 13. Verification. I (the Instructor) have developed and reviewed this plan with the student, the student has agreed to follow the plan, and understand consequences if the incomplete plan is not completed. Yes No Question Title * 14. Provide a detailed description of the incomplete plan that was agreed upon with the student. (include list of missing assignments and expected due dates) Question Title * 15. Electronic Signature of Instructor Question Title * 16. Date Date / Time Date Submit