Note: This page must be signed by your TA for you to receive permission to do a makeup lab activity for a missed lab. A copy of this sheet will be forwarded to the professor in charge of the course. Your TA will keep the signed original of this sheet.

A. Student Petition -- fill in and give this to your TA as soon as possible.

Date of this petition. __________________

Your Name: ________________________________________ Lab Section: ________

Your E-mail address (print): ________________________________________ Your Phone #: ___________

Date of Missed Lab: ____________________________

Title of Missed Lab: _______________________________________________________

Reason for Missing Lab: (explain as fully as possible – use reverse if more space is needed)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

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Documentation attached: ___ No ___ Yes, provided by ___________________________

B. Teaching Assistant Response -- to be filled in by authorized TA only.

TA name (print): _______________________________________________

Permission for makeup is: ____ granted ____ denied

TA signature: __________________________________________________

C. Negotiated Makeup due dates (only applicable if permission is granted)

Name of Makeup Activity: ______________________________________________

Date when student received makeup: ______________________________________

Due date for completed makeup: _________________________________________

Due time: _______________ Location to be handed in: __________________________

I agree that I will complete this makeup activity by the date indicated above. If so, the grade I receive on the makeup will substitute for the missed lab and missed quiz. If I fail to hand in the makeup activity on time, I lose this opportunity.

Signed: (student) ___________________________________________________