Extension Request Form
Mr. O’Leary
(Print, fill out and submit to Mr. O'Leary before the due date)





Project or Paper Assignment:

Original Due Date:


New Due Date:

Reason for Extension Request:




























Authorized by:



The student assumes responsibility for this extension and the new deadline. This form must be submitted with the paper/project or a late penalty will be assessed. If the student loses this form, a late penalty will be assessed. The paper and/or project are the responsibility of the student and in no way will the teacher excuse or accept unauthorized changes to this form or the process it implies. I the undersigned acknowledge my responsibility and absolve Mr. O’Leary of any legal responsibility for my actions, for my paper or for any injury I might incur in the performance of this extension:



Name Date