EXTENDED TIME REQUEST

Please fill in the information below if you would like to request extended time. While
your accommodations entitle you to this service, it is important that you use your
accommodations as tools for your success, and not as an excuse to procrastinate or
as a justification for holding onto inefficient habits.

Todays date:
Name of assignment:

Due date of assignment:

Proposed due date:

Explanation of request:

Requests made 24 hours before an assignment is due may be denied if you cannot
show evidence of effort to meet original deadline
Request response:

Student:_____________________________________________
Date:____________________________
General Education Teacher:_____________________________
Date:____________________________

EXTENDED TIME REQUEST

Resource Specialist:____________________________________
Date:____________________________