Extreme Circumstances Request Form

Extreme Circumstances Request Form
First/Given name as it appears on your passport*
Last/Family name as it appears on your passport*
Trine Student ID Number*
SEVIS ID Number*
Program*
Education Center*
Trine Student Email*
example@example.com
Extreme Circumstance*

Severe Sickness/IllnessCOVIDFlight CancellationTravel DisruptionsFamily EmergencyOther
There is no guarantee that extreme circumstances requests will be granted. A Trine University staff reviews student request on a case by case basis. You will be notified if your request has been approved or denied. You may be responsible to make up the hybrid requirement during a later term or semester.

Below please indicate the course code and course title of the course you are requesting to not attend and the semester and year of the course.
Course Code and Course Title*
BA 6933 Statistics and Quantitative Methods
Semester and Year of Course*
Fall 2022
Please upload evidence to support your request.*

Examples include: doctor's note, flight cancellation documentation, obituary, etc.
Cancelof
Optional second upload

Examples include: doctor's note, flight cancellation documentation, obituary, etc.
Cancelof
Optional third upload

Examples include: doctor's note, flight cancellation documentation, obituary, etc.
Cancelof
Should be Empty: