CSC 324 -- Winter 2009: REQUEST FOR SPECIAL CONSIDERATION
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  Homework/Test Number:  ____________      Date of Request:  _________________


  Student number: ___________________      Email address:  ___________________

  Last name:      ___________________      First name:     ___________________


Reasons for request (be concise and clear, use the reverse if needed; submit
supporting documentation together with this form, directly to your instructor):