CSC 263H1 -- Fall 2015: REQUEST FOR MAKEUP MIDTERM (9-10pm, Oct 22) 
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  Student number: ___________________


  Last name:      ___________________     First name:     ___________________ 


  Email address:  ___________________     Date of request: ___________________


Request for makeup midterm (Note that I will only accept a valid conflict
such as a conflicting course. Please be concise and clear):