MUHAS/PG.
F15
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
DIRECTORATE OF POSTGRADUATE STUDIES
APPLICATION FOR EXTENSION*
Name of Student: ………………………………………………………....................……............…
Registration No. ………………………………………………………....................................…..…
School: ……………………………………………………………….......................................….....
Department: ………………………………………………………....................................................
Degree/Diploma Proposed: ……………………………………..................................…………..…
Date of registration ……………………………………………............................................…….…
Name of Programme (Tick one):
Degree
Master
PhD
Studies due to end on ………………………………………………..................................………....
Extension requested (Tick one):
1st
2nd
3rd
If 2nd or 3rd, an extension fee receipt should be enclosed
Reasons for requesting an extension:
………………………………………………………….....................................................................
……………………………………………………….............…………………………………....…
…………………………………………………………..............…………………………………...
Period of extension: From ……………….............….. To ………………………..........…(Dates)
1
Recommendations by Supervisor:
1. Student’s progress...………………………………………………..............................................
.............................................................................................................................................................
.............................................................................................................................................................
2. Assessment of time needed............................................................................................................
3. When is the student expected to sit for final exam?........................................................................
Date……………………………..............…. Signature …………………………......………...……
Recommendations by Head of Department:
1. Student’s progress...………………………………………………..............................................
.............................................................................................................................................................
.............................................................................................................................................................
2. Assessment of time needed............................................................................................................
3. When is the student expected to sit for final exam?........................................................................
Date …………………………………………. Signature ……….............……....……….........……
Recommnendations by Dean/Director:
1. Student’s progress...………………………………………………..............................................
.............................................................................................................................................................
.............................................................................................................................................................
2. Assessment of time needed............................................................................................................
3. When is the student expected to sit for final exam..........................................................................
Date …………………………………....…… Signature ……….........…………………….........…
Chairperson, SHDC
Approved □ Not approved □
Date ………………………….. Signature ……………………………
*To be filled in quadruplicate. Submit all four copies.
