Requesting extension for OTC

This form is intended for faculty members who need to request an extension to complete the Online Teaching Certification (OTC) beyond the standard 30-day access period. We understand that unforeseen circumstances may arise, and this form provides an official way to request additional time. Please complete all sections thoroughly. Extension requests will be reviewed by the Office of the Dean of Academic Innovation & Technology and granted only under documented, extenuating circumstances.

Name:*

First NameLast Name

Email:*

example@example.com

Department:*

Department Chair:*

Chair email:*

example@example.com

Which OTC are you asking the extension for?*

Online Teaching Certification 1Online Teaching Certification 2

OTC 1 COMPLETED

Online Teaching Certification 1 COMPLETED workshops

OTC 1 PENDING

Online Teaching Certification 1 PENDING workshops

OTC 2 COMPLETED

Online Teaching Certification 2 COMPLETED workshops

OTC 2 PENDING

Online Teaching Certification 2 PENDING workshops

Reason for Requesting the Extension:*

I First Name* Last Name* understand that the extension is not guaranteed and may impact my eligibility for future teaching assignments in online modality if not completed by the revised deadline

Date submitted:

Date

Extension granted up to:

Date