Extension Review Form

Under extenuating circumstances, a program may request an extension of its program review. The request can be made by using this form and a confirmation email will be sent to the Department Chair, the Associate Director of Academic Assessment and Program Review, the Senior Director of Institutional Research, and the Dean.

Program/Department: *

Department Chair *

Department Chair Email *

College *

Dean *

Dean's Email *

The original date the self-study was due: *

Month

Day

Year

Newly proposed date of submission *

Month

Day

Year

Justifications for Extension Request: Please briefly explain below the extenuating circumstances for the request, and provide the intermediary steps the program will take to ensure timely completion of the program review by the new due date. *

Please acknowledge the following before you submit: *

	Yes	No
I have communicated this request with my Dean	I have communicated this request with my Dean - Yes	I have communicated this request with my Dean - No
I understand by submitting this extension request, a confirmation email will be sent to the Department Chair, the Associate Director of Academic Assessment and Program Review, the Senior Director of Institutional Research, and the Dean.	I understand by submitting this extension request, a confirmation email will be sent to the Department Chair, the Associate Director of Academic Assessment and Program Review, the Senior Director of Institutional Research, and the Dean. - Yes	I understand by submitting this extension request, a confirmation email will be sent to the Department Chair, the Associate Director of Academic Assessment and Program Review, the Senior Director of Institutional Research, and the Dean. - No
I understand the Senior Director of Institutional Research will review all requests, and consult with the Dean, and programs will be informed within 1 week if the request has been denied.	I understand the Senior Director of Institutional Research will review all requests, and consult with the Dean, and programs will be informed within 1 week if the request has been denied. - Yes	I understand the Senior Director of Institutional Research will review all requests, and consult with the Dean, and programs will be informed within 1 week if the request has been denied. - No

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Academic Assessment & Program Review

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